Little Black Dress Weekly Check-In Form Weekly Check-In Form for Success!Name:FirstLastStarting Weight (in pounds):Current Weight (in pounds):On a scale 1-10, what is your motivation level this week?:Worst12345678910BestWhat is your biggest accomplishment this week?:What is your biggest struggle this week?:What is your plan to overcome this obstacle?:How can we help you meet your goal?:How many times did you work out this past week?:1234567How many times do you plan on working out this upcoming week? (times & dates):Overall how would you rate your efforts in terms of working out? :Worst12345678910BestOverall how would you rate your efforts in terms of nutrition? :Worst12345678910Besttype_submit_reset_14SubmitReset Having problems submitting this form? Message our tech support by clicking here or email Ashley at firstname.lastname@example.org.