Halfway Revisit Form

Date

First Name

Last Name

What overall positive changes in your health and well-being have you noticed since starting your 6-month program?

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 is your main concern at this time?

Any changes in weight?

How is your sleep? Mood? Any constipation or diarrhea?

Are you exercising?

What foods do you crave and when?

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

Any other comments? Any questions about foods or ideas introduced so far?

Signature