Lets Get Started Survey | My Cable Dahmer

Please READ ALL options before selecting your plan.
A personal plan is for those who do not wish to join a challenge.
The Body Bootcamp and Transform Your Life plans are for those who wish to join a challenge.
Which plan do you want?

Personal Plan (DO NOT CLICK THIS IF YOU ARE PARTICIPATING IN A CHALLENGE)
Are there any challenges you would like to participate in?

Body Bootcamp (CLICK HERE IF YOU WANT TO JOIN THE BODY BOOTCAMP CHALLENGE)Transform Your Life (CLICK HERE IF YOU WANT TO JOIN THE TRANSFORM YOUR LIFE CHALLENGE)
Name*
Your coach would like to meet you. Please upload a photo of yourself here.

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Do you work at Cable Dahmer? If not who referred you? *
In a few short sentences tell your coach why you are pursuing health and fitness.
Email Address
Phone
Best Days to Connect via Phone

MondayTuesdayWednesdayThursdayFridaySunday
Best Time to Connect via Phone

MorningsAfternoonEvenings
What Cable Dahmer location do you work?

Cable Dahmer TopekaCable Dahmer CDJRCable Dahmer of Kansas CityCable Dahmer Buick GMC of Kansas CityCable Dahmer CadillacCable Dahmer KiaCable Dahmer Buick GMC of IndependenceCable Dahmer Chevrolet of IndependenceCable Dahmer Kia of LawrenceUltra Clean Lee's SummitUltra Clean Kansas CityUltra Clean IndependenceMartin HQ
Job Title
How many minutes is your commute to work?
Your Age:
Your Birthday:
Height:
Weight:
Goal Weight:
When were you at your goal weight last?
Do you have any health-related concerns that would hinder you following a diet or exercise plan?
Have you had any prior injuries such as sport related injuries?
Do you make your own meals?*

yesnosometimes
Do you eat dinner alone on a regular basis?*

yesno
What would you like to achieve in the workplace concerning your health and fitness goals?*
What do you do for exercise right now?*
Do you have a fit bit or device to count your steps?*

yesno
What is your biggest setback in living your Best Me?*
Do you have any food allergies?*
What are the strongest temptations you face in attaining or maintaining your healthy goals?*
List 3 of your favorite foods:*
If you could only eat one food the rest of your life, what would it be?*
What is your biggest temptation on a “diet?”*
What is your biggest setback in finding your healthiest life?*
Are you a salty or sweet person?

saltysweetboth!!
Do you prefer Mexican, Italian, American or any other food type more than others?
Feel free to share any additional information you know would help the coach to help you better.
What are the things you do now that you want to continue doing along your health and fitness journey?
We stay out of diet jail by eating the foods we like. Please list the foods you like and dislike. We stick with the likes. This isn’t intended to be a lifetime food list so don’t worry about getting it all down. This list just helps as we head in the right direction.*
What do you eat or drink before breakfast? Any Coffee, Creamer, coke, preworkout, etc.?
Do you eat breakfast?

yesno
If so, what time?
Do you have a morning snack?

yesno
If so, what time?
Do you eat lunch?

yesno
If so, what time?
Do you eat a PM snack?

yesno
If so, what time?
Do you eat dinner at home or at work?

homeworkdepends-on-what-daylittle-of-bothdont-eat-dinner-normally
If so, what time?
What are your after-dinner habits?
Do you have any nighttime eating habits?
Do you have any unusual habits after dinner that hinders your goals?
What are the nonalcoholic beverages you enjoy most?
How many alcoholic beverages do you enjoy during the weekdays?
How many alcoholic beverages do you enjoy on the weekends?
Are you a coffee drinker? How do you enjoy your coffee?
Do you drink carbonated beverages?

yesnosometimes
What is your favorite and most often consumed beverage?
How often do you eat out during the week?
How often do you eat out on the weekends?
Where do you eat out the most?
What are your favorite fast-food places?
List 1-3 of your favorite restaurants:
How does your weekend food and exercise routine vary from the work week?
Answers and information provided are strictly voluntary. Content is the sole intellectual property of Coach Mendy Lynn owner of New Me Fitness L.C. and content is not to be copied or shared. **

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