HALF-WAY REVISIT FORM

Name*
First Last
Email*
Phone
Date
MM slash DD slash YYYY
What overall positive changes in your health and well-being have you noticed since starting your program?*
What goals have been met?*
What recommendations did you find helpful and which do you continue to use?*
Are there areas you would like to focus on, shift, or approach differently in order to meet your goals?*
Please list any people in your life you think could also benefit from work like this.*
What is your main concern at this time?*
Any Changes with Weight?*
How is Your Sleep?*
How has Your Mood Been?*
Any stomach issues? Constipation, Diarrhea, heartburn...*
What foods Do You Crave and When?*
How has your eating been?*
Anything Else you Would Like to Share?*