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The Fabulously Keto Diet and Lifestyle Journal
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30 DCC Weekly Check In Form
Please complete before our call on Friday
Date
(Required)
MM slash DD slash YYYY
Name
(Required)
First
Last
Email
(Required)
Would you consider yourself successful this week?
(Required)
Yes
No
What were your wins this week?
Write them all down, no matter how small.
What have been your struggles? What hasn't gone so well?
What obstacles / challenges do your foresee for the next week?
What specific events or circumstances are coming up that I should know about, that may help or hinder your progress? What questions can I answer and I what can I help you navigate?
What would you like to take away from our next session?
Weight
Measurement around navel
Your Metrics
The following are optional metrics. Score how you would rate the following on a scale of 1 to 5. Where 1 is low/not good and 5 is the best it could be. These scores are subjective to you.
Energy on waking
Please enter a number from 0 to 5.
Movement
Please enter a number from 0 to 5.
General Health
Please enter a number from 0 to 5.
Energy mid afternoon
Please enter a number from 0 to 5.
Mental clarity
Please enter a number from 0 to 5.
Aches and Pains
Low score means little or no pain. High score lots of pain. Enter a score from 0 to 5
Mood
Please enter a number from 0 to 5.
Sleep
Please enter a number from 0 to 5.
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