Established Client Visit Client Name* First Last Date Time : HH MM AM PM How are you feeling?*ImprovedNo ChangeWorseCommentsUpdated Medication list/Discontinue or lessened by any amount?*Bowel Movements Per Day*My Energy Level Is*12345678910Any Change?*ImprovedNo ChangeWorseHydration (glasses/day):*12345678910I fall asleep easily _% of the time:*010%25%50%75%100%I stay asleep easily _% of the time:*010%25%50%75%100%Following Diet:*YesNoTaking Supplements:*YesNoHow many times have you been burst training this week?*How are you feeling about your program?*123456What do you want to keep working on?*Specifics:*Do you have any questions for us?PhoneThis field is for validation purposes and should be left unchanged.