Health Coaching Consultation Questionnaire

Health Coaching Consultation Questionnaire

The Good Life - "Optimize Bootcamp"
Full Name*

First NameLast Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Weight*
Lbs
What is your goal weight?*
How often do you workout?*

RarelyA couple times a monthOnce a week1-2x/weekMore than 3x/weekDaily
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you take any vitamins, please list them.
If you have any injuries, please list them.
Which of these are characteristic of your biggest issues:*

Brain fogExcess Body FatLow EnergyVisceral Fat (Belly fat)Strength Gain DifficultiesBloatingNot sure how to exerciseNot sure what to eat
Are you experiencing any stresses or motivational problems?*

YesNo
Do you suffer from diabetes, asthma, high or low blood pressure?*

YesNo
Please list:
Are you a current cigarette smoker?*

YesNo
Please rate your open-mindedness to a new way of eating.*

12345678910
Have you ever considered yourself lactose intolerant?*

YesNo
Did you know?

Raw milk offers several potential benefits compared to pasteurized milk. One advantage is that raw milk contains natural lactase, the enzyme necessary for lactose digestion. This means that individuals who are lactose intolerant can tolerate raw dairy products. Additionally, raw milk retains its natural nutrients, including beneficial bacteria, enzymes, and vitamins, which supports digestion and overall health. Raw butter, derived from raw milk, also retains these nutritional components and offers a rich source of healthy fats.

This will support you on your journey towards a fat-burning diet that will satitate you while you lower inflammation from processed carbohydrates and a gut filled with grains.
Do you still have issues incorporating raw milk?

YesNo
Most of these science-based tools include foods that have been incorporated into the meal plans for optimal results. Due to funded science and the collusion of our big pharma industry with big agriculture, most of these foods have been marketed as "bad for cholesterol". Click on the ones you have issues with to see more info.
Are you in any way concerned with incorporating these misunderstood superfoods - or foods of concern you'd like to know more about?*

Grass-fed Red MeatRaw MilkBeef TallowRaw HoneyI have NO issues and will be open to your advice
Why do you incorporate RED MEAT?!

There exists a significant misconception surrounding red meat, particularly its impact on human health. Grass-fed meats, in particular, offer unique nutritional benefits that can help prevent deficiencies and support hormonal balance. One key component found in grass-fed meats is vitamin K2, which plays a crucial role in directing calcium to our bones and teeth, preventing it from accumulating in our arteries or soft tissues. Adequate consumption of grass-fed meats, rich in vitamin K2, has been associated with increased bone density and reduced risk of fractures, as evidenced by compelling case studies. These findings emphasize the importance of including high-quality, nutrient-dense red meats in our diets to optimize our hormonal health and support our overall well-being.
Do you still have issues incorporating red meat?

YesNo
Which of the following benefits are you interested in achieving?*

Overall Gut HealthDecreased Body fatIncreased StrengthIncreased Bone DensityHormone Optimization
Do you have access to gym equipment?*

YesNo
If yes, specify what you can use.
As a health coach, it is crucial for clients to provide specific details about their dietary habits to ensure the most effective guidance and personalized meal plans. Understanding the specific foods they consume allows me to assess their nutritional intake accurately and identify potential sources of inflammation or nutrient deficiencies.
What are your usual meals? Be as specific as possible. (Products, Places, Stores, Types, Quantity, Quality)*

TImeline for achieving your goal.*

	4 WKS	8 WKS	12 WKS	6 MONTHS	UNTIL I WIN
NOW

(Optional) Peptides will speed up the process to reaching your goals, while also having anti-aging properties and increased recovery times. Would you like to hear more about our enhanced recovery program?

YesNo
Is there anything else, specifically, you would like to achieve through this program?
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS & CONDITIONS!*

YesNo
Email to send the results and scheduled consultation:
example@example.com
MY CREDENTIALS

As a health coach with a background in computer science from CSUF and a focus on data analytics, I bring a unique perspective to the field of nutrition and wellness. I am passionate about integrating evidence-based research, human biology, and science-based tools to promote a natural diet that avoids industrialized chemicals and manufacturing methods.

My expertise lies in understanding the impact of nutrition on human health, particularly when it comes to the consumption of animal-based diets. Through my extensive knowledge of data analytics, I have analyzed scientific studies that highlight the benefits of incorporating raw dairy, grass-fed meats, and healthy fats into our diets. These nutrient-rich sources can provide essential vitamins, minerals, and proteins that support optimal bodily functions.

One crucial aspect I emphasize is the avoidance of processed foods and vegetable oils, commonly referred to as seed oils. Scientific research has consistently shown that these oils contain high levels of omega-6 fatty acids, which, when consumed in excess, can contribute to chronic inflammation and various health issues. By prioritizing fresh meat and produce, we can harness the vital nutrients and antioxidants needed for overall well-being.

To further solidify my expertise, I hold certifications as a Certified Nutrition Coach and am a Certified Personal Trainer. Additionally, I am a NASM certified virtual coach, allowing me to provide personalized guidance and support remotely. I have taken my progress seriously over the past 6-7 years, having gained 50 pounds of lean muscle mass. With my passionate and enthusiastic curiosity in the workings of biomechanics, nutrient deficiency, and result-based methods, you're in good hands. I only utilize the latest research on human physiology and integrative nutrition. These credentials demonstrate my commitment to staying up-to-date with the latest scientific advancements and techniques in the field of nutrition and fitness.

In conclusion, as a health coach, I offer a unique blend of skills rooted in computer science, data analytics, and a deep understanding of human biology. My focus on evidence-based research, coupled with my certifications in nutrition coaching and personal training, positions me as a trusted expert in the field. I am dedicated to guiding individuals towards a lifestyle that prioritizes fresh, nutrient-dense foods and empowers them to make informed decisions about their health.
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