Intake Questionnaire
First Name
Last Name
Phone
*
Email
*
In general, what are your goals? Check all that apply.
In general, what are your goals? Check all that apply
How, specifically, would you like your habits, your health, your eating, and/or your body to be different
Have you tried anything in the past (or recently) to change your habits, your health, your eating, and/or your bod
If so, which of those things worked well for you, and why?
Which of those things did not work well for you, and why?
If you were to consider maybe making more changes to your habits, your health, your eating, and/or your body, what might those be?
Until now, what has blocked you or held you back from making these changes?
Right now, how would you rank your overall eating/nutrition habits?
Are you regularly active in sports and/or exercise?
If so, about how many hours per week, on average?
Considering your current situation for exercising, how long do you WANT to exercise each time you?
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