Health & Fitness Lifestyle Assessment
Please, fill in this form before our call.

You will get better idea of what you are looking for and I will be able to see how I can assist you to have more energy, be more fit and relaxed or how to influence your children by example to lead a healthy lifestyle.

Email address *
Name *
What is your goal in this area of your life? *
How important is improving your health & fitness to you right now to? *
Not important
It is my top priority
How long have you been trying to resolve your challenges? *
What have you tried so far to work on this area of your life? *
What worked and what did not work? *
What seems to be the major obstacle in achieving your desired results? *
Do you follow any special diet? *
Do you have any health issues or take medications? If yes, please list them. *
How does your typical day look like? Please describe your job and day outside of the job with your activity level in mind. If you know how much time you spend walking or how many steps you take a day, list it here. *
How many times do you work out during your typical week? What does your workout look like? How long are your workouts? How intense are your workouts? *
How much sleep do you get daily? *
How satisfied are you with your sleep?
I feel constantly sleep deprived!
I feel fresh as ever and utmost satisfied!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service