Coach — Core 22

Step 1 - Answer Any Time

0

The following questions will bring any obvious shortcomings to your attention. Our coaching advice to you at the end of this process will only be as good as the information you give us here, so please shoot for honest accurate answers. Once we identify every possible point, you will be able to decide which, if any, to focus your attention on.

1

First Name*

2

Last Name*

3

Todays Date*

4

Starting Weight*

5

Current Weight*

6

Target Weight*

7

How long have you been having difficulty losing weight?*

1-4 Days

5-7 Days

Week +

8

Consider the Past few days or more When Answering the Following Questions

9

Please describe what's happening*1 of 69

10

11

In the past three days or more have you eaten or drank something you know is not on the approved list?*2 of 69

Yes

No

12

If you answered yes, what things have you been eating or drinking that you know are not on the approved list?*3 of 69

13

If you do not purchase and prepare your meals yourself, you cannot know for sure what you are eating or if any unapproved ingredients were added. In the few days leading up to your weight loss slow, how often did you purchase food that was cooked or prepared by someone other than yourself?*4 of 69

Never

1-2Xs/week

3-7Xs/week

8+Xs/week

14

List the places you purchased prepared food over the last few days or more.*5 of 69

15

How often are you eating a hand full of vegetables titled Unlimited?*6 of 69

Never

1-2 Xs/week

3-4 Xs/week

5-7 Xs/week

16

How often do you eat between one and two handfulls of vegetables titled Limited?*7 of 69

Never

1-2 Xs/week

3-4 Xs/week

5-7 Xs/week

17

How often do you eat the daily recommended amount of protein without eating more than you should?*8 of 69

0/w

1-2/w

3-4/w

5-7/w

18

How often do you use sugar, artificial sweeteners, or honey?*9 of 69

Never

1-2 Xs/week

3-4 Xs/week

5-7 Xs/week

19

When you eat fruits or vegetables, how often are they organic?*10 of 69

0%

50%

75%

100%

20

What processed food (from a box, bag, or can) did you eat over the few days leading up to the weight loss slowing?*11 of 69

21

Did you eat any beef or poultry that was not organic?*12 of 69

Yes

No

22

Did you eat any seafood that was not wild caught?*13 of 69

Yes

No

23

How often over the past week did you consume wheat or dairy products; even in small amounts?*14 of 69

None

1-3 times

4 or more times

24

Are you doing a decent job getting enough sea or Himalayan salt?*15 of 69

Yes

At Times

No

25

How often did you exceed 2 tablespoons of oil, or salad dressing per a day?*16 of 69

Never

1-2 Xs/week

3-4 Xs/week

5-7 Xs/week

26

How often did you use non-organic herbs or spices?*17 of 69

Never

1-2 Xs/week

3-4 Xs/week

5-7 Xs/week

27

How often did you have more than two servings of approved fruit per day?*18 of 69

Never

1-2 Xs/week

3-4 Xs/week

5-7 Xs/week

28

Did you use something other than an avocado or coconut cooking spray to cook?*19 of 69

Yes

No

29

What did you use?*20 of 69

30

Are you drinking close to half your body weight in ounces of water?*21 of 69

Yes

No

31

How much water per day are you drinking?*22 of 69

32

How confident are you that the water is free of impurities?*23 of 69

I'd bet my success on it

I'm not sure

33

Are you still often thirsty?*24 of 69

Yes

No

34

Do you urinate eight or more times per day?*25 of 69

Yes

No

35

How often over the past week did you eat within three hours of going to bed?*26 of 69

None

1-3 times

4 or more times

36

Sleep

37

How often are you getting at least seven full hours of uninterrupted sleep?*27 of 69

Never

1-2 Xs/week

3-4 Xs/week

5-7 Xs/week

38

Describe your typical sleep pattern over the past few weeks AND... the time you fell asleep last night and woke this morning.*28 of 69

39

Medications

40

Are you taking any prescribed or over-the-counter medications?*29 of 69

Yes

No

I'm skipping this

41

Have you recently started or changed the medications you take?*30 of 69

Yes

No

I'm skipping this

42

Do any medications you are taking have water retention or weight gain as a knownside effect?*31 of 69

Yes

No

Unsure

43

Exercise

44

Do you exercise (run, swim, take fitness classes, speed walk, bike, lift weights, etc.)*32 of 69

Yes

No

45

Please describe your exercise schedule, frequency, and intensity*33 of 69

46

Have you been exercising hard enough to cause muscle soreness that lasts a day or longer?*34 of 69

Yes

No

47

Did you start or change your exercise routine shortly before having difficulty losing weight?*35 of 69

Yes

No

48

Please describe the date the change occurred, how the duration and intensity changed, and the timing the change had with your weight loss difficulty.*36 of 69

49

Does exercise make you extra hungry or cause you to deviate from the program at times?*37 of 69

Yes

No

50

How often do you feel you exercise at an intensity above the 70% maximum fat burning zone?*38 of 69

Never

1-2 / week

3-4 / week

5-7 / week

51

Do you sometimes feel it is OK to eat more than recommended or cheat because you exercised?*39 of 69

Yes

No

52

Stress, Constipation, Menstrual Water Retention, Sleep, Alcohol

53

How much stress would you say you are experiencing recently?*40 of 69

Minor

Moderate

Significant

54

How often do you have a bowel movement?*41 of 69

1-2Xs / week

3-5 Xs / week

6-7Xs / week

55

Is it possible that water retention caused by a menstrual cycle is part of the issue?*42 of 69

Yes

No

56

How many days since you last had a bowel movement?*43 of 69

57

Please describe your alcohol consumption over the past two weeks?*44 of 69

58

Supplements

59

Do you take all four of the recommended supplements each day?*45 of 69

Yes

No

60

How often do you forget to take one or more as recommended?*46 of 69

Never

1-2 Xs/wk

3-4 Xs/wk

5-6 Xs/wk

61

What, if any, other supplements or nutritional shakes are you using? Please include the name and brand in case we have to look them up.*47 of 69

62

Your Goal

63

When you started the program you were asked to consider why it's important for you to lose weight. What are your reasons for wanting to lose weight today?*48 of 69

64

On a 1 - 10 scale, how important is it to you for you to reach your goal?*49 of 69

65

Personal Grit

66

How often over the past week did you knowingly deviate from the program (eat someing not approved, use alcohol, eat just before bed, etc)?*50 of 69

Never

1-3 times

4 or more times

67

Are there any principles you have decided not to use at all?*51 of 69

Yes

No

68

Which of them could you start using, even if just part of the time?*52 of 69

69

Are there some principles you could apply more consistently?*53 of 69

Yes

No

70

Which could you apply more consistently?*54 of 69

71

Has socializing with friends, family, or coworkers caused you to deviate from the program?*55 of 69

Yes

No

72

What could you do to prevent that from happening again?*56 of 69

73

Do you have any habits, things you do at certain times, or situations that can cause you to slip up.*57 of 69

Yes

No

74

Please describe and explain how you can prevent them from happening again?*58 of 69

75

Can you think of one or more recent situations that caused you to deviate from the program?*59 of 69

Yes

No

76

Please describe and explain how you can prevent them from happening again.*60 of 69

77

What if any justifications have you used to cheat on the program?*61 of 69

I will lose weight eventually, and I'm not in a hurry.

I deserved the moment of enjoyment

I'm already happy with my results, so it's not as important

I wasn't prepared, so I just did what I had to

It was outside of my control

I felt awkward so I just went with what felt more comfortable

78

Please explain any other justifications. (Explaining will make it harder to justify in the future)*62 of 69

79

How many friends, family, or coworkers are registered to follow your progress?*63 of 69

80

How often do you leave them comments or success stories?*64 of 69

Never

Daily

Weekly

81

General Questions

82

Do you feel the program is confusing?*65 of 69

Yes

No

A little

83

What about the program do you feel is confusing? (Knowing will help us help others in the future)*66 of 69

84

Do you feel the program is difficult to follow?*67 of 69

Yes

No

A little

85

What about the program do you feel is too difficult? (This will help us improve the program)*68 of 69

86

Are there any changes or improvments you think would make the program better for you?*69 of 69

87

88