Halfway Revisit Form

All of your information will remain confidential between you and the Health Coach.

First Name:

Last Name:

Green Machine

H E A L T H

CSL

Personal Information

What overall positive changes in your health and wellbeing have you noticed since starting the six-month program?

Health Information

What goals have been met?

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

What recommendations did you find 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 are your main concerns at this time?

Are you exercising?

Food Information

Any changes with weight?

How is your sleep?

Constipation or diarrhea?

How is your mood?

What percentage of your foods do you cook/prepare at home?

What foods do you crave and when?

Today's Date:

Breakfast:

Lunch:

Dinner:

Snacks:

Liquids:

What is your diet like these days?

Anything else you would like to share?

Additional Comments

Catherine Stewart-Lindley | Green Machine Health

greenmachinehealth@gmail.com | 917-699-8790