Check-In ~ darrickbynum

If the question doesn't apply to you or you don't know the answer put N/A

Name*

First Last

Email*

Enter Email Confirm Email

Current weight*

Previous weight*

How did you feel on the diet?*

What’s your waking heart rate for today?*

Name of Current Diet?*

What’s your blood pressure for today?*

Did you take all your vitamins for the week as stated on your plan?*

Yes
No
Sometimes

Did you follow the meal plan 1-100% ?*

Did you feel fatigued this week?*

Did you do any outside cardio; if so tell me in detail?*

Did you see any changes in your body this week?*

How many times did you fall off the diet, not including your scheduled cheat meals?*

What was the hardest part of the diet?*

How was your stress level this week?*

Bad
Medium
Good
Off and On Stress

How was your digestion?*

How many weeks on your current diet?*

Did you eat sweets this week?*

Did you drink alcohol in the last 30 days?*

What 2 body parts do you want to see improvement on this week?*

What’s the average amount of sleep you had this week?*

How well did you sleep?*

Good
Medium
Bad

Did you bike ride this week?*

Yes
No

Did you do outside cardio?*

Yes
No

Which form of cardio did you do?*

Steady state cardio
HIIT
All of the above
None

What's the total of hours of cardio you did this week?*

What days did you do cardio?*

Did you feel constipated this week?*

Yes
No
Sometimes

What was your average number of bowel movements per day?*

Did you have any floating stool?*

Yes
No
Sometimes

Did you take any medication this week?*

Yes
No

Please list what medication you took and why?*

Please list all vitamins you took this week.*

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