Weight Management Consult Par Q
The answers provided via this form will help me to gain a better understanding of your needs, strengths, weaknesses, and interests. Each answer helps me to build the steps needed for you, personally, not a one size fits all program. Thank you for taking it seriously and answering honestly so that I can better help you reach your goals by providing direction and the tools needed for your success. ***Always consult your physician before starting any lifestyle changes.
Email address *
Name *
Your answer
Email address *
Your answer
Birth date: can be just the year
MM
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DD
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YYYY
Mailing Address: *
Your answer
Limitations/injuries/diagnosis that impact your ability to workout *
Your answer
Dietary restrictions/allergies *
Your answer
What is your current fitness level? *
Are you training for something specific? *
Your answer
What are your favorite formats? *
Are you currently a member of a gym? *
What are your top fitness goals? *
What are your top nutrition goals? *
How many times per week do you eat out? *
What keeps you from working out consistently? *
Do you work outside the home? *
What do you have for a typical breakfast? *
Your answer
What do you have for a typical lunch? *
Your answer
What do you have for a typical dinner? *
Your answer
What are your go to snacks? *
Your answer
How much sleep do you get per night? *
Are you nervous about making a change to your lifestyle? *
Is there anything that you would like to share with me to help me better understand YOU and your needs/wants? *
Your answer
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