Health & Wellness Progress Report

Name (First & Last)

Today's Date

What are the 3 biggest wins you have experienced so far?

Have you noticed a change in self confidence? Explain. Please rate your self confidence on a scale from 1-10

Have you noticed a change in energy levels? Explain. Please rate your energy on a scale from 1-10

Have you noticed a change in overall mood? Explain. Please rate your mood on a scale from 1-10

Have you noticed a change in mental health, stress levels and/or anxiety? Explain. Please rate your mental health on a scale from 1-10

Have you noticed a change in digestive health and bowel movements? Explain. Please rate your digestive health on a scale from 1-10

Have you experienced a change in libido? Explain. Please rate your libido on a scale from 1-10

Have you noticed a change in weight, measurements, body composition or photos? Please explain

Have you noticed a change in sleep? Explain. Please rate your sleep on a scale from 1-10

Have you noticed a change in hair, skin & nail health? Explain. Please rate it on a scale from 1-10

What would you like to improve over the next 2 weeks

What are some potential barriers to reaching your goals? How will you work around them?

How can I best support you?

What has been the most helpful part of the program so far?

Is there anything you would like to change or see done differently?