Health Assessment
The answers to these questions help me to understand your current health "snapshot" and how to best individualize your program and support you in the best way possible.
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Email *
Name *
Phone *
Birth Date *
Current Weight *
Height *
What benefits would you like to experience in the next 30-90 days? *
If Weight Loss Checked Above - How Much Would You Like To Lose? (pounds)
If Weight Gain Checked Above - How Much Would You Like To Gain? (pounds)
When I gain body fat, I put it on around *
I am 100% Coachable (open to suggestions to set me up for success and stretching me out of my comfort zone *
If Selected No or "Other" please explain % and why
I prefer to be contacted by *
My current level of motivation to accomplish my goals is *
very low
very high
Why is your motivation where it is? How will your life be different if you reach your goals. *
The challenge (s) I see myself having over the next 30 days is / are: *
My current level of stress in my life is: *
laid back all the time
totally stressed out
My main sources of stress are: *
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