Your First & Last Name
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Phone
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Overall, how are you feeling about your progress?
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1 - Completely off track, I need help ASAP!
2 - Off track and struggling quite a bit
3 - Slightly off track but still in control
4 - On track with only minor bumps
5 - Fully on track and feeling great
List your biggest 2–3 wins from the past 30 days:
Anything counts: consistency, strength, habits, mindset, energy, etc.
Over the past 30 days, how would you rate the following, on average?
Sleep quantity:
Less than 6 hours
6 - 6.5 hours
6.5 - 7 hours
7 - 7.5 hours
7 - 8 hours
8+ hours
Sleep quality:
1 - Awful
2 - Poor
3 - OK
4 - Good
5 - Excellent
Stress levels:
1 - Drowning
2 - Strained
3 - Manageable
4 - Low
5 - Very Relaxed
Overall energy levels:
1 - Completely Wiped
2 - Tired Most Days
3 - Up & Down
4 - Good
5 - High & Consistent
30-day average daily step count:
Under 5,000 steps per day
5,000 - 7,000 steps per day
7,000 - 9,000 steps per day
9,000 - 11,000 steps per day
11,000+ steps per day
Out of 10, how challenging have your sessions been feeling, on average?
5/10 or less: Too easy, doesn't feel productive
6/10: Feels good but not very challenging
7/10: Challenging but very manageable
8/10: Very challenging but still productive
9/10 or greater: Extremely challenging / near max effort
How would you describe your eating habits over the last 30 days?
Mostly aligned with my goals and nutrition plan
Decent, but portions or consistency slip
Quality is good, timing is messy
Convenience-driven / reactive
I feel stuck or overwhelmed with nutrition
I'm not following a plan right now
(Choose the closest fit)
What is your single biggest nutrition challenge right now?
Time & scheduling (busy days, irregular meals)
Stress or emotional eating
Evening or late-night eating
Portions / feeling overly full
Eating out, travel, or social events
Consistency (starting strong, fading off)
Knowing what to focus on
Motivation or follow-through
Nutrition hasn’t been a challenge lately
What do you think matters MOST for your success over the next 30 days?
Consistency with training
Nutrition habits
Sleep & recovery
Stress management
Daily movement
Mindset / motivation
Time management / scheduling
Where do you feel you need the most help or support right now?
Accountability / check-ins
Nutrition guidance
Adjustments to training
Help managing schedule or stress
Motivation / mindset support
I’m good right now
Is there anything specific that would improve your session experience right now?
Optional; short answers welcome
At this point, how likely are you to recommend us to a friend or colleague?
Anything else you'd like us to know, or that would be helpful to share?
SUBMIT