CHOICE
Study ID
Weekly Call Sheet
Date:
/
/
1. Are you following the diet accordingly?
Yes
No
a. If no, what problems are you having?
b. Would you like the dietitian to call you?
Yes
No
2. What is your total weight loss for the week?
What is your current weight?
3. What are your total steps for the week?
4. Have you started any new medications?
Yes
No
If yes, what are they?
5. Are there any issues you would like to discuss?
Yes
No
If yes, what are they?
My name :
My eMail address is :