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Nutrition Coaching Preliminary Questions
Thank you for taking the time to complete these preliminary questions before our consultation.
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Email
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Please Enter Your Full Name
Your answer
What do you notice about your energy levels?
Your answer
How do you feel about yourself when you look in the mirror?
Your answer
What are your main reasons for seeking health and fitness advice?
Your answer
Why now and not 6 months ago?
Your answer
What are your goals and how will you feel when you achieve them?
Your answer
How confident are you in achieving your goal?
Not Confident
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Very Confident
Clear selection
How committed are you to achieving your goal?
Not Committed
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100% Committed
Clear selection
How will your life improve when you get these results?
Your answer
What excites you the most about getting to your goal?
Your answer
How many meals including snacks do you eat each day?
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Clear selection
Do you feel that a properly structured nutrition and exercise program would benefit you?
Yes
No
Clear selection
Do you eat breakfast?
Yes
No
Clear selection
Are you taking supplements?
Yes
No
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Do you crave sugary foods?
Yes
No
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Do you often experience digestive difficulties?
Yes
No
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How long have you been exercising?
Your answer
Have you reached and maintained your goals?
Yes
No
Clear selection
Are you happy with the way you look and feel and with your health?
Yes
No
Clear selection
On a scale of 1 to 10, how serious are you about achieving your goals?
Not Serious
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Very Serious
Clear selection
Please list your desired fitness goals:
Weight Loss
Increase muscle
Sport performance
Better health
Increased confidence
Do you have high cholesterol?
Yes
No
Clear selection
Has your doctor ever said that you have heart trouble?
Yes
No
Clear selection
Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?
Yes
No
Clear selection
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