Please, Tell Me A Little About You
There’s a story we all tell ourselves about who we are and what we’re capable of. My training style and philosophy will help you reconsider / rewrite your self story. It’ll help open the door to changing your body and boosting your confidence.
"Change your eating, your body, and your health from the inside out.” I talk about the “ working in” thing a lot when explaining what sets my coaching apart from other programs that claim to help you get fit. You see, inner change — exploring and shifting how you think about your life, your body, and who you are — is necessary to make lasting outer change.
Even learning / grooving the basics: what to eat, how much to eat, and when to eat requires you to change how you think, plan, and strategize, at least a little.
Change your insides, change your outsides.
Lets get started below.
What is Your First and Last Name?
17 - 25
25 - 35
35 - 50
Where do you live, city and state? (its not shared publicly)
What has you interested in working with me today?
The Platinum Assessment/And Workout
Eat Well, Move Well, Live Awesome Boot-Camp (online or in person)
Golf Fitness, Training For Strength, Mobility and Injury Prevention
Primal Pattern Training: The Most Important 7 Moves You Will Ever Do or Need to Do
Stiff Guy Yoga. Mobility, Stability, Back Back Rehab, General Flexibility
Just Want to Chat With You
I Need a Complete Makeover of My Lifestyle and Health and Fitness Routines
In Your Own Words, Why Are You Interested In The Above Program You Elected? Write as much as you possibly can please.
What is Your Chief or Biggest Complaint When It Comes to Your Health or Fitness?
Are you member at a gym?
I Have a Home Gym/Exercise Room
How did you first hear about me and my company The Wellness CSI
My Doctor, Nurse, PT, Massage Therapist, Nutritionist, Accupuncturist
I saw your post or video on Facebook
I found you through a Google search
A friend / family member told me about you
I got your flier in my home leasing welcome packet
Met you out and about, you gave me your card
Overall, how happy are you right now with your current health, nutrition, and/or fitness choices?
Very unhappy; I feel overwhelmed and lost when it comes to nutrition and exercise.
Fairly unhappy; nothing I've tried in the past has been sustainable.
So-so; I generally know what to do but can't always stick to it.
Very happy; I feel great about how I look and feel.
Which Options BEST Describes Your Current Situation? (you can choose more than one)
I Need Help in Habit Change, Lifestyle Management and Better Nutrition
I Want to Build More Strength, Endurance a Elevate My Metabolism
When it Comes to Health, Fitness, and Nutrition, I Struggle to Stay Motivated
I Just Want to Get Back In Shape Physically
I Just Want To Lose Some Weight
I'm Just Stuck, Have Tried Other Programs, Nothing Seems to Work
My Energy Level Is Low, I Don't Sleep Well, I Have Trouble With Digestion and Mental Focus,
I'm Chronically Sick or Just Don't Feel Well Most of The Time
What's something that would make you feel happier about your choices? (Choose all that apply.)
A clear nutrition plan and program
A better relationship with food / eating
Coaching / guidance
Recovering from a chronic injury or illness
A regular exercise routine
Understanding what to prioritize
Making better choices more consistently
More help and support
Less stress; fewer demands
What do you think is your biggest hurdle to changing how you look and feel?
How important do you think it is to have someone monitor your progress, keep you accountable, and help you stay consistent?
General Eating Patterns: As best as you can remember right now, tell me generally about an average day of eating and drinking? Please Include Time of Day and What you might normally eat and drink?
Right now, are you following any particular diet or style of eating?
If yes, what? And for how long have you followed this way of eating?
On a Scale of 1-10 , how consistent would you say you are with your eating habits?
ALL Over The Place
If you are less consistent than you'd like to be, what seems to get in the way or knock you off your tracks?
Do you have any issues with
When You Eat
What You Eat
Parasites, Fungus or Yeast (I know gross right!)
Waking Up Tired but Wired
Energy Drop Offs During The Day
Tell my a bit more about your answers above. How long? When? What have you tried that hasn't worked?
How often do you have a bowel movement each day?
More Than 3 Times Daily
2-3 Times Daily
1-2 Times Daily
Once Every 2-3 Days
A Few Times A Week
Weekly or Less?
Do you feel like you have trouble controlling your appetite / hunger?
Always Famished Get Me Some Food!
Do you feel like you have trouble controlling your appetite ? hunger?
Sometimes it Depends
Have you ever noticed any connection between stress and your eating habits? If yes, what happens? Like "when I'm stress I eat more /less of...
If yes sometimes what do you normally crave? And what do you normally do when you have cravings?
We Will Talk About Your Daily Habits and Environment like. How often do you eat out, make meals at home, how often do you shop, do you like cooking? When we speak.
Your Goals and Priorities! Thinking about all that you have written down so far, what do you think you might like to start working on or addressing first?
Right now: Do you have someone in your life who makes sure you're accountable and consistent when it comes to your health, nutrition, and/or fitness choices?
Where do you feel like you need the most help with regarding your health, nutrition, and fitness? (Choose all that apply.)
Emotional Eating / Overeating / Eating More Regularly Through the Day
Exercise and Moving More During The Week
Reducing Medication Use
Getting More / Better Sleep / Better Recovery
Longevity Strategies / Disease Care / Aging Issues
Specific Health Concerns
If you could make ONE very small improvement to your health, nutrition, and/or fitness choices right now, what might it be?
Send me a copy of my responses.
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