Weekly Accountability Form Name * First Name Last Name Date of Check In Call * MM DD YYYY Energy * Very Low Energy Low Energy Normal Energy High Energy Very High Energy Mood * Awful Mood Bad Mood Ok Mood Good Mood Great Mood Stress * Stress Free Moderate Stress Normal Stress High Stress Extreme Stress Sleep * Less than 7 hours / night 7-9 hours / night More than 9 hours / night Daily Step Count * I do not track steps Less than 2500 2500-5000 5000-7500 7500-10000 10000-12500 12500 or more Start Date of Last Menstrual Cycle or N/A MM DD YYYY Hydration * Less than 1/2 my bodyweight in oz. Equal to 1/2 my bodyweight in oz. More than 1/2 my bodyweight in oz. Number of Meals Made/Consumed outside of Home * None - All meals from home 3 meals or less 4 meals or more Alcohol Consumed * None 2 drinks or less 3 drinks or more Nutritional Plan Adherence * F - Inadequate (0-59%) D - Poor (60-69%) C - Average (70-79%) B - Good (80-89%) A - Excellent (90-100%) Exercise Plan Adherence * F - Inadequate (0-59%) D - Poor (60-69%) C - Average (70-79%) B - Good (80-89%) A - Excellent (90-100%) Overall Self-Assessment * I'm falling apart - Help! I'm struggling a little - a work in progress I'm doing OK - I will do better! I'm doing really good - I got this! I'm crushing it! Which habits are you most proud of this week and why? * Which habits fell short this week and why? * What areas do you need help building confidence? * Any wins you'd like to share? * What habits will you commit to improve in the next week? * What barriers or obstacles do you foresee in the next week? * Any Additional Questions / Comments for your coach? * Thank you!