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TRM CHECK IN & STATS
Full Name:
*
Today's Date:
*
+
SLEEP RESULTS
Compared to previous week, how is your sleep result?
*
Better
Same
Worse
On your scale, what is your sleep result?
*
Poor
Fair
Good
Excellent
Following answers must equal 7
How many mornings did you wake up exhausted (have to will yourself out of bed) in the last 7 days?
*
0
1
2
3
4
5
6
7
How many mornings did you wake up fatigued (need another hour of sleep) in the last 7 days?
*
0
1
2
3
4
5
6
7
How many mornings did you wake up recovered (got enough sleep) in the last 7 days?
*
0
1
2
3
4
5
6
7
How many mornings did you wake up refreshed (more than enough sleep) in the last 7 days?
*
0
1
2
3
4
5
6
7
SLEEP RESULT (-14 to +14)
0
Calculate
How many times did you wake up during the night on average this week?
*
None - slept all the way through the night this week
1
2
3
Other:
Other:
ENERGY
Compared to previous week, how is your overall energy this week?
*
Better
Same
Worse
How would you rate your overall energy this week?
*
Poor
Fair
Good
Excellent
FOCUS & CONCENTRATION
Compared to previous week, how is your overall focus and concentration this week?
*
Better
Same
Worse
How would you rate your overall focus and energy this week?
*
Poor
Fair
Good
Excellent
PAIN LEVELS
On a scale of 1-10, how would you rate your overall pain levels today?
*
1
2
3
4
5
6
7
8
9
10
Where are you experiencing pain or tension this week?
*
No Pain
Feet
Ankles
Knees
Legs
Hips
Low Back
Shoulders
Neck
Head
Other
Other
If you are experiencing pain or tension, is it:
Constant
Intermittent
Infrequent
Comments about pain or tension:
HOMEWORK
How many days did you take a CASUAL WALK this week?
*
0
1
2
3
4
5
6
7
How long were your CASUAL WALKS on average this week?
*
20 minutes
30 minutes
45 minutes
60 minutes
Other
Other
How many days did you complete TRUMPET breathing this week?
*
0
1
2
3
4
5
6
7
Please fill out below if assigned. If not, just answer "0".
How many times a day did you complete TRUMPET CLUSTERS (a set of 5 Trumpets)?
*
0
1
2
3
Other:
Other:
Please fill out below if assigned. If not, just answer "0".
How many days did you complete PAUSE & PINCH breathing this week?
*
0
1
2
3
4
5
6
7
Please fill out below if assigned. If not, just answer "0".
How many days did you S-T-R-E-T-C-H this week?
*
0
1
2
3
4
5
6
7
Did you have any issues with the stretches this week?
*
Yes
No
If yes, what stretches are you having issues with and why?
SUCCESSES
Any breakthroughs or "base hits" this week? (Select all that apply)
*
Improved sleep quality
More energy/more productive
Better decision-making
Improved reaction to stress
Other:
Other:
Give an update on your Mindset
*
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