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Potential Fulfilled " ' Consultation Form
I love getting to know my clients before starting pro gramming. This allows me  to get an idea of your current lifestyle, mindset, and learning personality in order to make a efficient plan for you. Please take the time to answer these questions as honestly as you can, I look forward to working with you. 
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Email *
General Profile
Full Name (First, Last) *
Gender at Birth  *
Pronouns  *
Phone Number *
Age *
Height *
State you live in *
Do you have a sedentary job or an active job? *
Any health conditions that apply to you (mental as well as physical) *
Any medications that you take/what they are for *
Personality
List a word or two that describes you *
What is your daily stress level on a scale of 1-10 (1,stress free 10, I'm on the verge of a breakdown) *
What mechanisms do you use to manage stress in your life? *
Are you easily discouraged or tend to stay motivated through tough situations? *
Current lifestyle
How much water do you typically drink a day? *
Do you consume alcohol? If so how frequently? *
List the foods you ate yesterday *
Do you have any diet restrictions? (Please Explain) . *
Have you participated in any FAD diets? A fad diet can generally not be followed long term. If so please let me know which one. *
Are you currently taking any supplements? If so please list them below. *
Do you currently workout? *
How frequent do you workout?
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What is the intensity of your workout?( List the exercises of one of your most recent workouts and how you felt).
Your Goals
What made you reach out? *
Are you interested in online or face to face training? *
Are you interested in doing a bodybuilding competition? *
What has made developing a healthy lifestyle challenging? *
In the past, what  methods have worked best for you? Which have not? *
Are you ready to change your perspective on health and wellness?   *
How did you hear about me? *
Please indicate best times for face to face or phone call consultation. *
A copy of your responses will be emailed to the address you provided.
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