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Client Tracking

Please complete the following form and click "submit" when you are done.


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):

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:

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