Caileen Thomas

Nutrition Coach

Online Checkin Form

    Client Information

    First Name
    Last Name

    Body Composition

    What was your weight this morning?

    Measurements

    Arm
    Chest
    Thigh
    Waist

    Meals and Intake

    On a scale of 1-10 rate your adherence to nutrition/macros?
    Water Intake - How many ounces daily on average?
    What describes your hunger best?
    How many unplanned meals did you have? i.e: Planned on Chicken and Veggies, but ate Subway instead.
    For example: you planned to have chicken, rice and a veggie BUT had a burger instead.
    How many times did you eat out this week?
    Do you have any foods that you are craving or would like added to your meal plan?
    NoYes
    Tell us about the foods. We will see if they will fit in the macros!

    Activity, Mood, Sleep

    How is your energy?
    Rate your energy from 1-5
    Any changes in your mood or attitude? i.e: Irritable, Cranky, Happier, More Anxiety NoYes
    Please explain the changes
    Workouts - How many times?
    Are you recovering from them efficiently? For example: excessive soreness, energy after, pain, etc. NoYes
    Sleep - Average hours per night
    Stress - Rate from 1 to 10 (1 being no stress)
    Do you have any new life stressors? NoYes
    Describe the new stressors

    Additional Information

    Did you have any wins this week? NoYes
    Tell us about your wins.
    Did you have any struggles, if so please explain:
    Do you have any additional bio feedback or input that will assist us in putting together your plan?