Leah V. Fitness - Personal Fitness Training
Client Tracking
 
Please complete the following form and click "submit" when you are done. 
Name:
Week of:
On a scale of 1-10 (10 being the best), rate your adherence to the goals/focus set forth in your nutrition plan:
Overall, how did you feel this week (tired, low energy, normal energy, hungry, satisfied)?
What positive changes did you make this week (choices you are proud of, or may not have made prior to beginning a re-structured nutritional plan)?
What obstacles/struggles did you encounter this week & how did you deal with them?
What changes will you make next week that will help you in meeting your goals (as set forth in your current nutritional plan/stage)?
If you are traveling, have a change in work schedule, or will be attending family/social gatherings/parties, outline your plan to assist you in making healthy nutritional choices:
Please check all that apply (in regards to the entire week):
I ate every 3 hours ea day
I ate at least 2-3 cups of vegetables ea day
I drank at least 1.5 Liter of water ea day
I consumed processed foods that were high in sugar
I drank more than 2 alcoholic drinks this week
At times, I felt dizzy due to low blood sugar
I consumed within my caloric goal this week
I had 4-5 total meals (incl. "snacks") ea day
I consumed candy, cookies or sweets this week
I felt that I overate at times this week
I struggled with making healthy choices this week
On average how many hours of sleep are you getting each night?
Check each day in which you participated in planned, moderate intensity exercise for 30 min. or more:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
 
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