Check in with Victoria

Please fill out the check in form to the best of your ability.

Name *

First Name

Last Name

Date

MM

DD

YYYY

Age

Email Address *

Exercise:

Were you able to be compliant to your current exercise program or goal?

How many conditioning (cardio) sessions are you doing per week & how long/type? Please be specific.

How was your strength? How's your body doing/feeling? (ex: past or current injuries, personal records, setbacks, etc.)

Have you noticed any physical progress? (ex: clothes fitting looser or visual changes. Please describe)

Have you noticed any health-related progress (ex: easier breathing climbing stairs, less migraines, better posture, etc.)

Nutrition:

If you are counting macros please include your current total and how long you have been on that macro total.

Lifestyle:

What lifestyle habit are you currently working to improve?

What were your greatest obstacles since last check-in?

What were your greatest victories since last check-in?

How was your sleep/rest quality & amount? Please discuss any changes to sleep, good or bad.

Please discuss your level of hunger since last check -in.

Describe your mood/mental state.

Stress level (1-5, 5 being the most stressed)

1

2

3

4

5

Energy level (1-5, 5 being the most energetic)

1

2

3

4

5

Optional Data:

Current weight first thing in the morning:

Previous weight from last check-in:

Current Measurements:

Bust (nipple level):

Waist (measured around your belly button):

Hips (along your inguinal crease & around your butt):

Previous Measurements:

Bust:

Waist:

Hips:

Any other comments or concerns:

How else can we support you?

Thank you!