About You
First name
Last name
Email
Phone
Birthday
Month
Day
Year
Height
Weight
Goal weight (if applicable)
Occupation
Preferred communication method
Goals & Motivation
What are your top 3 goals right now, in order of importance.
Why are these goals important to you?
What happens if nothing changed in the next 6 months?
On a scale of 1-10, how committed are you to making changes right now?
What would success look like in 90 days?
What would success look like in 1 year?
Health History
Do you have any diagnosed medical conditions?
Yes
No
Are you currently pregnant or postpartum?
Yes
No
Are you taking any medication?
Yes
No
Have you had any surgeries or injuries?
Yes
No
Any chronic pain, joint issues, back pain, pelvic floor issues, diastasis recti, etc.?
Yes
No
Do you experience dizziness, chest pain, shortness of breath, fainting, or rapid heartbeat during exercise?
Yes
No
Has a doctor ever told you to avoid exercise?
Yes
No
How would you rate your stress level?
1-5 (low to mod)
5-10 (mod to high)
How many hrs of sleep do you average a night?
Nutrition & Habits
Walk me through a typical weekday of eating.
Walk me through a typical weekend of eating.
How often do you eat out weekly?
How often do you cook at home?
Do you currently track calories/macros?
How much water do you drink daily?
Do you drink alcohol? How often?
Biggest struggle with nutrition right now?
What foods do you love and never want to remove?
Schedule & Lifestyle
What does a normal weekday schedule look like?
When can you realistically train?
How many days can you commit to movement?
What responsibilities compete for your time?
How often do travel, kids, work, or events disrupt routine?
Budget
Are you looking for the cheapest option, best support, or best long-term results?
If coaching solved your current struggle, what would that be worth to you monthly?
Are you ready to financially prioritize your health right now?
Food
How much money do you estimate you spend on groceries monthly?
Do you shop mostly premium, moderate or strict budget grocery options?
What stores do you usually shop at?
Coaching Preferences
What kind of coaching style motivates you best?
Do you need accountability, education, structure, or emotional support most?
How honest are you willing to be when struggling?
Are you expecting overnight results?
What is the true cost of staying where you are right now?
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