Name * First Name Last Name Email * Phone (###) ### #### List all of your concerns with your health, eating habits, physical fitness, and/or body: * Out of those things, list them in order starting with number one priority: * What are you prepared to do to work towards your goals? * What do you expect from me as your coach? * Do you have any non-negotiables? If so, explain. * Have you tried anything in the past to change your eating habits, your lifestyle habits, your health and/or your body? * Did that work for you? Why or why not? * Do you have experience tracking your food with an app like MyFitnessPal, MyPlate, Chronometer? * Do you have experience weighing your food with a food scale? * What are some foods that you like to eat the most? * What are some foods that you don't like to eat at all? * Do you have any known/diagnosed food allergies/intolerances? * Have you ever noticed a connection between your emotions and eating habits? * Have you ever noticed a connection between your stress levels and eating habits? * On average, how many hours do you sleep a night? * Do you own a food scale? Yes No Have you been diagnosed (currently or in the past) with any significant medical condition(s) and/or injuries? * Right now, do you have any specific health concerns, such as illnesses, pain, and/or injuries? * Right now, are you taking any medications, either over-the-counter or prescription? * Are you currently taking hormonal birth control? Please include your current age, height, bodyweight. * Which program are you interested in? * Month to month 6-month commitment What is your anticipated start date? * Thank you!
