Weekly Check-in Form

WEEKLY CHECK-IN FORM CLIENT INFORMATION ================== Name: _____________________________ Week of: ___________________________ Session Number: ____________________ Coach: ____________________________ PROGRESS REVIEW =============== 1. How would you rate your overall week? 1 ── 2 ── 3 ── 4 ── 5 ── 6 ── 7 ── 8 ── 9 ── 10 (1 = Very challenging, 10 = Excellent) 2. What were your biggest wins this week? ___________________________________ ___________________________________ ___________________________________ 3. What challenges did you face? ___________________________________ ___________________________________ ___________________________________ GOAL PROGRESS ============= 4. Rate your progress on your main goal this week: ☐ Exceeded expectations ☐ Met expectations ☐ Made some progress ☐ No progress ☐ Moved backward 5. What specific actions did you take toward your goal? ☐ Action 1: _______________________ ☐ Action 2: _______________________ ☐ Action 3: _______________________ ☐ Other: _________________________ 6. What prevented you from making more progress? ___________________________________ ___________________________________ ENERGY & WELL-BEING ================== 7. How were your energy levels this week? ☐ Very high ☐ High ☐ Moderate ☐ Low ☐ Very low 8. How well did you take care of yourself? ☐ Excellent ☐ Good ☐ Average ☐ Poor ☐ Very poor 9. What self-care activities did you engage in? ☐ Exercise/Movement ☐ Healthy eating ☐ Adequate sleep ☐ Meditation/Mindfulness ☐ Social connection ☐ Hobbies/Fun activities ☐ Other: _____________ RELATIONSHIPS & COMMUNICATION ============================= 10. How were your relationships this week? Family: ☐ Great ☐ Good ☐ Okay ☐ Challenging Friends: ☐ Great ☐ Good ☐ Okay ☐ Challenging Work: ☐ Great ☐ Good ☐ Okay ☐ Challenging Romantic: ☐ Great ☐ Good ☐ Okay ☐ Challenging ☐ N/A 11. Any relationship insights or challenges to discuss? ___________________________________ ___________________________________ LEARNING & GROWTH ================ 12. What did you learn about yourself this week? ___________________________________ ___________________________________ 13. What patterns did you notice in your behavior or thinking? ___________________________________ ___________________________________ 14. How did you step out of your comfort zone? ___________________________________ ___________________________________ LOOKING AHEAD ============= 15. What are your top 3 priorities for next week? 1. ________________________________ 2. ________________________________ 3. ________________________________ 16. What support do you need from your coach? ___________________________________ ___________________________________ 17. What would make next week a success? ___________________________________ ___________________________________ GRATITUDE & REFLECTION ====================== 18. What are you most grateful for this week? ___________________________________ ___________________________________ 19. If you could redo this week, what would you do differently? ___________________________________ ___________________________________ 20. Additional thoughts or items to discuss in our next session: ___________________________________ ___________________________________ ___________________________________ COACH NOTES SECTION ================== (For coach use only) Observations: ___________________________________ ___________________________________ Action items for next session: ___________________________________ ___________________________________ Follow-up needed: ___________________________________ ___________________________________