BODZii, Metabolic Assessment
Please fill out this form prior to booking your call so we can best guide you!
Name (please enter first and last name)
*
First Name
Last Name
If applicable, what's your name on your Facebook Profile? (only answer if your name is different so we can find you)
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
How old are you?
*
What do you do for work?
*
Tell me, what are your current health and fitness goals? (weight loss, performance, energy increase....)
*
What have you tried in the past in an effort to reach these goals? Have they worked? Have they not? Why or why not?
*
How long have you been trying to lose weight and keep it off?
*
< 1 year
1-3 years
3-6 years
6+ years
Let's go over a couple of lifestyle questions. Rate the statements from 1-5 below. I make time for healthy habits.
*
Never
1
2
3
4
Every day
5
1 is Never, 5 is Every day
I eat slowly.
*
Never
1
2
3
4
Every day
5
1 is Never, 5 is Every day
I eat mindfully, with few distractions. I notice the taste and texture of my food.
*
Worst
1
2
3
4
Every day
5
1 is Worst, 5 is Every day
I include some lean protein at most meals.
*
Never
1
2
3
4
Every day
5
1 is Never , 5 is Every day
I include colourful fruits and vegetables at most meals.
*
Never
1
2
3
4
Every day
5
1 is Never , 5 is Every day
I eat mostly slow-digesting, high fibre, nutrient rich carbohydrates such as fruits, starchy vegetables, whole grains, or beans/legumes.
*
Never
1
2
3
4
Every day
5
1 is Never , 5 is Every day
I eat mostly whole, minimally processed foods.
*
Never
1
2
3
4
Every day
5
1 is Never , 5 is Every day
Do you track your calories
*
Yes
No
If yes, please enter in your average calorie intake below.
I plan most of my meals. (Or I have a trusted system such as meal delivery.)
*
Never
1
2
3
4
Every meal
5
1 is Never , 5 is Every meal
How many glasses (~250mL) water do you drink daily?
*
< 2
2-5
5-8
8-12
I exercise or do some movement.
*
Never
1
2
3
4
Every day
5
1 is Never, 5 is Every day
I make time to relax, have fun and de-stress.
*
Never
1
2
3
4
Every day
5
1 is Never , 5 is Every day
I have at least one positive, supportive social connection.
*
Disagree
1
2
3
4
Agree
5
1 is Disagree , 5 is Agree
I can manage my stress or emotions without relying on food and eating.
*
Disagree
1
2
3
4
Agree
5
1 is Disagree, 5 is Agree
I do purposeful recovery.
*
Never
1
2
3
4
Every day
5
1 is Never , 5 is Every day
I practice good "sleep hygiene" and try to get plenty of high quality sleep.
*
Never
1
2
3
4
Every day
5
1 is Never , 5 is Every day
How many hours of sleep do you get a night?
*
4
4-6
6-8
8+
Do you drink alcohol?
*
Yes
No
If yes. How many days a week?
1-2
2-4
4-6
Every day
Do you take any medication?
*
Yes
No
Please list below
Where did you get this form?
Please Select
Facebook post
Facebook DMs
Instagram
TikTok
Email
Other
Lastly, please type in your own words what you feel you're having the hardest time with right now and why you believe you aren't seeing the results you'd like.
*
Thanks for filling all that out! It helps us understand you, your history and your goals a lot better. Are you interested in discussing our coaching plans and options? Our program is for long-term dieters who are serious about long-term weight loss and overall health - not about quick fixes. Programs range from $78/mo. for a DIY program to $450/month for 1:1 Customized Coaching.
*
Definitely interested. I need personalization.
Not sure yet.
No. I won't book a call when brought to the next page and will continue to learn from the free resources you provide.
Hit submit to finish your form! You'll be taken to a call page to book a free assessment with us to discuss your goals and get you on the right path,
Back
Next
Submit
Should be Empty: