Strength by Kris - Health Assessment
PLEASE COMPLETE THIS FORM AT LEAST ONE DAY PRIOR TO OUR SCHEDULED CALL
Email address *
Name *
Your answer
Phone Number *
Your answer
Gender *
How did you hear about me? *
Your answer
What health issue(s) would you like to overcome with nutrition? *
Your answer
How long have you been dealing with the health issue(s) or when were you diagnosed? *
Your answer
Right now, how would you rank your overall eating / nutrition habits? *
Horrible
Awesome
Do you currently exercise 3-5 times per week? *
If yes, what types of workouts or movement do you do? Check all that apply. *
Required
Is your job active or sedentary? (Active meaning walking and being on your feet all day, sedentary meaning sitting at a desk most of the day) *
What type of work do you do? *
Your answer
How would you rank your daily stress levels? *
Calm
On the verge of panic attacks
How would you rank your quality of sleep? *
Wired and tired
Master of sleep
What is the most important topic you'd like to discuss on our call?
Your answer
Thank you for your information and I look forward to talking to you soon!! ~ In Strength, Kris
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