5 Month LifeStyle Alignment Program Halfway Review

Please write or print clearly.

Your First Name *

Your Last Name *

Your Email *

Which overall positive changes in your health and well-being have you noticed since starting your 5-month program? *

Which goals have been met? *

Are there areas you’d like to focus on, shift, or approach differently in order to meet your goals? *

What recommendations have you found helpful and which do you continue to use? *

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 other thoughts/ comments?

Any changes to your energy levels?

Your energy (/10) *

Sense of calm (/10) *

Focus + concentration (/10) *

Any changes with your weight? *

Any changes with your overall blood sugar levels? *

How is your sleep? (/10) *

How are your mood + focus? *

What progress have you made with your training? *

Food information

To give a current snap-shot, please list the items you ate and drank yesterday below...

Breakfast: *

Lunch: *

Dinner: *

Snacks: *

Liquids: *

Any questions about concepts or recommendations introduced so far?

Any questions about foods or ideas introduced so far?

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