Weight Loss Coaching
For me to be able to help you to the best of my abilities, I will need a little information about you. After you've completed the questionnaire I will be in touch to arrange your phone consultation. ALL FIELDS MUST BE COMPLETED!
My fitness/health/body goal is...
I have tried to change this part of my life...
Once or twice before
My overall body image is...
My goal is important to me because...
Do you suffer from or have you ever suffered from
Do you have any medical conditions I need to be aware of before I can coach you?
Are you currently taking any medications?
If you answered YES, please list below (name, dosage, for what, how long)
I mostly need help with the 3 following areas...
How would you rate your stress levels?
How many hours of sleep do you get on an average night?
Less than 5 hours
More than 8 hours
My best times for consultations with you are...
Feel free to inform me of anything else that you might deem important for me to know before we work together
How did you find me?
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