Information Request Form

Lady Queen Sherri Elizam Detailed information sheet

Please take the time to fill out to the best of your ability with lots of detail.
Tell me about your lifestyle. The more detail you provide, the better your results. I want to know about every single thing you have eaten with the time of day..
Name

First NameLast Name
Age
Weight
Height
E-mail
example@example.com
Phone Number

Area CodePhone Number
Breakfast: Give detail, what are you having ?
Drinks?
(coffee, water, juices,) or anything else not mentioned
Supplements ?
Medication?
a.m. snack- food
Drinks ?
Supplements ?
Lunch: : Give detail, what are you having ?
Drinks ?
Supplements ?
p.m. snack: Give detail, what are you having ?
Drinks?
Supplements?
Dinner: Give detail, what are you having ?
Drinks?
Supplements?
Late night snacking: Give detail, what are you having ?
Drinks?
Supplements?
Any other info I need to know?
currently using pre workout drinks, supplements?
What time do you workout?
Length of workout ?
Types of workouts?
Post workout drinks?
Sleep- what time do you go to bed?
What time do you wake up everyday ?
YesNo
YesNo
If you answered no to previous question, Please explain & are you open to working on improving the quality of your sleep with my sleep management supplementation program?
answer accordingly
Stress level: 1-10 (1 being lowest & 10 being highest)
1-10 stress level
What normally causes you stress and or anxiety?
Give details
YesNo
If answered Yes to previous question
If so, how long , & how often? )
Are you currently reading ? If so, what book ?
Name of book or books
What is the ultimate goal you would like to achieve on this program ?
Give detail
Why did you decide to join the Lady Queen Program ?
What is an absolute must for you while on this program ? What are you looking to achieve ?
Give detail
Feel free to tag me in any of your posts or stories. proudly feel free to add Ladyqueensherrielizam as your coach on your IG bio. Once you tag me, I will always tag you back !
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Lady Queen Sherri Elizam Detailed information sheet