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Inner Circle Check-In Form

What's your email?

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What's today's date?

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Did something go really well since last we checked in?

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Did something go really well since last we checked in?

A

Yes

B

No

Did something not go so well since last we checked in?

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Did something not go so well since last we checked in?

A

Yes

B

No

Do you feel good about your Wellness Plan so far?

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Do you feel good about your Wellness Plan so far?

A

Yes

B

No

Do you feel like you have accomplished something towards your goal this week?

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Do you feel like you have accomplished something towards your goal this week?

A

Yes

B

No

Is there anything with your plan you think needs changing?

Is there anything with your plan you think needs changing?

A

Yes

B

No

I understand that this wellness plan is educational and informational only, and is not intended to diagnose, treat, or replace professional medical advice. I agree to consult my healthcare provider before making any major changes to my health routine.

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I understand that this wellness plan is educational and informational only, and is not intended to diagnose, treat, or replace professional medical advice. I agree to consult my healthcare provider before making any major changes to my health routine.

Yes, I understand.