Name
*
First Name
Last Name
Email
*
Phone
(###)
###
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Gender
FEMALE
MALE
Height
Current Weight
What are your short term goals?
What are your long term goals?
How do you want to feel when you finish your program?
What are the areas you would like to see the most progress in?
What is your current nutrition like?
Do you have experience tracking your nutrition? Calorie tracking / Macro tracking?
Have you been on any form of a diet in the last 6 months, if so explain.
How much time do you currently spend cooking?
Do you have experience meal prepping?
How many times a week do you eat out / order in?
Do you have any food allergies or dietary restrictions?
Do you have any current or past illnesses deficiencies, or diagnosis that i should know about?
Are you on any medications? If so, what?
What supplements or performance enhancers are you taking, if any? Please list dosages.
How is your sleep schedule and how much sleep do you get per night
Do you workout? How many days a week?
What do you do for a living, are you on your feet or sedentary?
Tell me about your schedule and lifestyle. What does a week in your life look like?
Now tell me about a day in your life! Daily schedule, morning routine, kids, family, what time is dinner? The better I understand your day, the better I can program things that work with your existing life!
Who does the cooking at home? And how many people are. you general feeding on weeknight and weekend dinners?
Favorite Foods!
Foods you do not like / will not eat!
Any foods or recipes your family loves? Sunday traditions? Things you want to be able to keep in your plan?
Where is your mental health in regards to your health? How do you feel about yourself, how does your health play a role in your mindset, love for yourself, how you feel each day.
What made you ready to commit to coaching?
What are some obstacles, behaviors, or activities that could potentially slow your progress. Lets dive deep here. I can only be the best help to you on this journey if i know where your weaknesses may be. This can be time management, dieting, accountability, anything.
Tell me something about YOU! Favorites, music, hobbies, anything!
Questions / Comments / Any additional info.
