Name
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First Name
Last Name
Phone
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(###)
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What week of the process are you on?
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On a scale of 1-5, how much effort did you give your plan this week?
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1
2
3
4
5
Did you complete all your scheduled workouts this week?
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Yes
No
Did you follow your meal plan as written and/or track your macro targets in MyFitnessPal everyday this week?
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Yes
No
Are you having regular bowel movements daily?
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Please explain. For example: how many times per day, stool is too hard, frequent diarrhea, etc.
If applicable, what supplements, medications and/or PEDs, GLPs are you currently taking?
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Please note the dose, date of starting use, and how many weeks you've been on this regimen. "What you told me," is not a helpful answer as things do change. I need to know what you did this week in to order to adapt nuances of your plan. For example: Past 10 weeks: Mulit -1 tab 1x day, Creatine - 5mg 1x day, Chaste berry 2 caps 1x day, DHEA 1 pump 1x day Just started this week: Medi-pure 1 scoop 2x a day, etc. to the best of your recollection.
Please update me on any changes you've noticed since starting your hormone or gut health protocol.
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Please note how consistent you have been with it.
How are you feeling physically?
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For example: seeing more definition, bloated, a bit fatigued on your menstrual cycle, etc.
How are you feeling mentally?
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What is your biggest win for the week?
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Was there anything that you struggled with this week?
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How did you feel about your workouts this week?
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What are you doing to continue to reach your goals next week?
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Is there any additional support you could use from me to be more successful through this process?
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What is something you learned about yourself this week?
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