Journal

This form is to be filled out and submitted by current clients only!

* Indicates required field

NAME *

First

Last

Entry is for what DAY & DATE: *

EMAIL *

Rate your Level (*all entries required)

How many hours of sleep did you get last night? *

Quality of sleep? (1) = poor to (10) = high/ great *

Stress? (1) = low to (10) = very high *

Energy? (1) = low to (10) = high/ great *

Mood? (1) = low/bad to (10) = high/great *

Fitness (optional entry)

Walk, Run, Cycle, Eliptical or Cardio Class: Type & Mins.? *

Steps? *

Miles? *

Weights or Strength Training Class: Minutes? *

Pilates: Minutes? *

Yoga: Minutes? *

Sport/ Other: Type & Mins.? *

Hydration (*all entries required)

Water: How many 8 oz. servings? *

Tea: How many 8 oz. servings? *

Coffee: How many 6 oz. servings? (TALL latte is 12 oz.) *

Other, if applicable *

You may complete the Food Log or the Food Journal or Both

Food Log (optional entry)

Protein: How many palm-sized servings? *

Vegetables, non-starchy veggies: How many fist-sized servings? *

Fruits: How many fist-sized servings? *

Grains/ Starchy Veggies: How many fist-sized or cupped-hand-sized servings? *

How many full-thumb-sized servings? *

How many indulgences (fried, high-fat, sweets, soda, alcohol, etc.)? *

Any cravings? My response to Cravings? *

Multivitamin/ Supplements taken? Yes or No *

Females (General guidelines for Servings)

Males (General guidelines for Servings)

Food Journal (optional entry)

BREAKFAST: When, where, what did you eat? *

LUNCH: When, where, what did you eat? *

DINNER: When, where, what did you eat? *

SNACKS: What did you eat? *

Any cravings? My response to cravings? *

Reflection (optional entry)

Positive Thing(s) that happened today? *

What, if anything, can I do to make tomorrow better? *

Submit

LIFESTYLE JOURNAL

This form is to be filled out and submitted by current clients only!

Rate your Level (*all entries required)

Fitness​ (optional entry)

Hydration ​ (*all entries required)

Food Log​ (optional entry)