Initial Assessment

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Initial Assessment

Please complete the following as accurately and completely as possible

Email *

Tell Me More About Yourself

By learning more about your lifestyle and your habits, I can take better care of you and make sure coaching is a good fit for your goals and individual needs.

First & Last Name *

Date of Birth *

YYYY

Gender *

Female

Male

Other

How Did You Hear About Me? *

Height *

Current Body Weight *

Ideal Body Weight *

Daily Activity *

Sedentary - Sitting at the computer most of the day, or sitting at a desk.

Lightly active - Light industrial work, sales or office work that comprises light activities.

Moderately active - On your feet comprised of moderate activity (ex: Cleaning, kitchen staff, or delivering mail on foot or by bicycle.)

Very active - Heavy industrial work (iron, coal, etc.), construction work, brick mason, or farming.

Workout Activity *

Sedentary - No working out

Lightly active - Low intensity aerobics

Moderately active - High intensity aerobics or weight training

Very active - Weights 3+/week + aerobics

Extremely active - 2+ hrs/day and athletes

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