EmailMe Form - Over 40 Nutrition Weekly Report Form

Name *

First Last

Date Time *

MM / DD / YYYY

Days Since Last Photos *

Bodyfat % (if known)

Current Weight *

Rate Your Meal Plan Adherence on the scale below *

Any off plan meals? If so, Why?

Any skipped meals? If so, Why?

How was your energy level?

How was your strength?

How was your water consumption?

Rate Your Exercise Adherence on the scale below *

Weekly Sleep Patterns

Please give brief synopsis of how you feel, and any info pertaining to current week that you think is or is not necessary:

Please list any issue with meal plans or timing:

Any menu requests? (please be aware that these are not always granted):

Now for your input. Please list anything you think I can do to make things easier for you with your plans. Please dont list make menu changes faster because I work as fast as I can as it is:

Images:

These are a MUST for any coaching program.

Please take pics in a well lit area with a solid light or white background (no busy backgrounds). Same place, same time of day, same day each week, same outfit if possible.

Guys: Boxers, briefs, etc..
Ladies: Bikinis, sports bra and tight shorts.

These pics are meant to show detail of your body to help evaluate progress and losses in specific areas.

Front View:

Side I

Side II

Back View