Name * First Name Last Name Email * Date of Birth * MM DD YYYY Beginning Weight * This is the weight you started your journey Current Weight * This is the weight you just got from your scale How many weeks have you been at your current weight or not losing? * Weeks at current weight Are you tracking your daily intake? * Yes or No Do you know how many calories you should have in a day for 1# weight loss? * Yes or No How many calories do you eat per day on average? * daily calorie intake What lifestyle habits have you recognized as unhealthy? Have you changed them? * Diet or exercise changes How many grams of protein are you eating daily? Your tracking app will tell you * amount of protein Have you been managing your constipation? * Yes or No How many ounces of water are you drinking daily? * 80 Have you increased your body movement daily? * Activity per week Thank you! We will be in touch soon!
