Get to know you!

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.

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Name *

Date of birth *

Gender *MaleFemaleOthers

Mobile number *

Email *

How do you prefer me to contact you? *

• Email
• Phone
• Video chat
• Whatsapp/Text

Emergency contact number and name *

In general, what are your goals? *

• Lose weight/fat
• Gain Weight
• Maintain weight
• Gain muscle
• Improve physical fitness
• Look better
• Feel better
• Get stronger
• Improve athletic performance
• Get control of eating habit

What do you expect from me as your coach? *

Have you tried anything in the past to change your habits, your health, your eating and / or your body? *

If you never tried anything, please answer NO

Which of the things that you tried worked well for you?

Which of the things that you tried didn't worked well for you?

What has been blocking you from achieving your goals? *

Have you have been diagnosed (currently or in the past) with any significant medical condition(s) and / or injuries? *YesNo

Right now, do you have any specific health concerns, such as illnesses, pain, and / or injuries? *YesNo

Right now, are you taking any medications, either over-the-counter or prescription? *YesNo

If you answered Yes to any of the above 3 questions, please provide more details

On average, how many hours per night do you sleep? *

• 4 or fewer hours
• 5 hours
• 6 hours
• 7 hours
• 8 hours
• 9 hours
• 10 or more hours

How do you normally cope with your stress? *

Disclaimer, please recognize that it is your responsibility to work directly with your health care provider before, during, and after seeking nutrition and / or fitness consultation. Any information provided is not to be followed without prior approval of your doctor. If you choose to use this information without such approval, you agree to accept full responsibility for your decision.

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