New Client Form
Please fill out the form to the best of your ability, so I can help you as much as I can.
Email *
What is your weight? (in Kg) *
What is your height? (in cm) *
How old are you? (in years) *
Have you ever tried losing/ gaining weight before? *
What method of weight gain/ loss did the diet involve? Tracking calories? Improved nutritional habits? Food restriction? What did you do to change your weight or keep it the same? *
Can you describe how that went? *
On a scale of 1 to 10, 10 being perfectly adherent, can you rate your overall adherence to that "diet"? *
On a scale of 1 to 10, 10 being the perfect mood state, can you rate your overall mood during the day when you were on the "diet"? *
Do you know how many calories you currently take in on average? *
How many calories do you eat per day (If applicable)?
Do you have a weight scale? *
Other than sending weight updates, which of these methods of progress tracking are you comfortable with (you can check more than one option)? *
Do you have a food scale? *
Are you willing to track the food you eat? (Keep in mind that it could be a really accurate way of getting results) *
If you have ever worked out before, can you describe what your goals were when performing the workout? *
Can you describe how you felt when you worked out? *
On a scale of 1 to 10, 10 being super energized and not tired at all, how did you feel, in terms of energy, throughout the day after your workout? *
How many steps do you hit per day (if you track them)?
What kind of exercise equipment do you have access to? *
What do you expect out of this service? How can I best help you? Why did you choose to do this? *
A copy of your responses will be emailed to the address you provided.
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