Nutrition Initial Questionnaire
Congratulations! We want to take a moment to commend you for taking the steps toward a healthier and happier lifestyle. To get started we need to determine your goals and assess where you are in relation to achieving them. Below is a list of questions to complete.

ONCE YOU COMPLETE THE FORM WE WILL SEND THE WELCOME EMAIL WITH THE NEXT STEPS
 
It is important for you to set aside time to write your responses. Please understand that it may take you 10-20 minutes to complete. I will use this information to create an individualized plan for you. From time to time we will evaluate your progress, celebrate wins, and revise the plan if needed.

Remember, this is YOUR JOURNEY. As your coach, I am committed to working as hard you are willing to work to help you achieve your goals. But it is up to you to DO THE WORK!
 
I recommend using a notebook to track your progress, plan, and journal during your journey.

Congratulations again!

Email *
What is your goal? What do you want from your nutrition and fitness plan? *
Why is this goal important to you? Why now? What will happen if this does not change? What will it feel like if this does not change? *
On a scale of 1-10 (10 being the most), how committed are you to achieving your goals? *
Not at all
This is an absolute MUST!
Nutrition Log - Create a 3-5 day log of your nutrition. Be sure to include meal times and portions/serving sizes. Try to be as accurate as possible, but if you do not have accurate measurements please estimate serving sizes. *
Fitness log - Create a 1 Week log of your fitness routine. Include, day, time of day, planned workouts and activities. *
Water Intake - Approximately how many ounces per day do you drink in water? (Water only, do not count any other liquids) *
Sleep - Approximately how many hours of sleep do you get most nights? *
Mindset - Do you have any mindset practices? (meditation, affirmations, visualization, reading, etc.) Please share frequency, time of day, and practices. *
Challenges - What do you feel is the biggest challenge preventing you from accomplishing your goals? *
What would success look like for you? If you accomplished your goals, what would your life be like? How would this make you feel? *
A copy of your responses will be emailed to the address you provided.
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