Previous Week Weight
How well did you follow your diet?
1 (did not follow at all)
2 (missed more than 5 meals or went off plan more tan 3 times)
3 (missed more than 3 meals or went off plan more than 2 times)
4 (missed only 1 meal or went off plan no more than 1 time)
5 (perfect week)
If you went off plan, why? and what was it?
How was your energy levels this week?
2 (Low levels all day)
3 (mid day crash)
4 (evening crash)
5 (energetic throughout the day)
How do you feel about your current nutrition?
1 (hate it)
2 (dislike it, but tolerable
3 (Indifferent, I just consume as necessary)
4 ( I like it)
5 (I love it)
Do you want to add anything?