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Nutrition Coaching Exit Survey
Indicates required field
Chest Measurement (inches) - measure at nipple level
Waist Measurement (inches) - measure 1 inch above navel
Hip Measurement (inches) - measure at the fullest part of your butt
How was your mood this last week?
On cloud nine
Pretty darn good
Not my favorite week
Feel free to elaborate here:
How was your energy?
I was very productive and had lots of activity
Lots of activity with some loafing
Half and half.
Low energy most days.
What were stress levels like?
Nada. No stress this week
Some stress, but manageable.
Stressed a lot but not all week.
Would you like to tell me more about that?
How was your hunger level?
I had trouble getting all of my food down. Can you tell me how to eat for less volume to help this?
I was hungry a couple times.
I felt very hungry most days.
How was sleep?
Slept through most nights and felt rested!
Had trouble falling asleep or staying asleep.
I could hardly sleep at all.
How closely did you follow your template this last week? (Please be honest.)
50/50 or worse
If you chose 70/30 or below, please elaborate on this. For example, were you having tough cravings? Try to explain what took you off the path to your goals.
Please give me a little more detail about your week here.
SHAKTI FIT YOGA AND TRAINING STUDIO
14 E. Gambier St Mount Vernon, OH 43050
YOGA. TRAINING. NUTRITION.
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