Email *

Full Name *

Step goal/Average Daily Steps *

How well did you sleep this week? *

How were your stress levels this week? *

• Extremely High
• High
• Normal
• Low
• Extremely Low
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How were your energy levels this week? (0 being no energy; 10 being off the charts energy) *

• 0
• 1
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• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10
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How were your hungry levels this week? ( 0 is too full/unable to eat; 10 is starving) *

• 0
• 1
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• 3
• 4
• 5
• 6
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• 8
• 9
• 10
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Average Daily Water Intake in ounces *

Successes you had this week? *

Is there anything you are currently struggling with at the moment? *

Please list any supplements like hormonal and sleep support: *

Anything else you'd like to mention or let your coach know? *

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