SandyFit- Empowering Your Journey: Mindset, Fitness & Nutrition Consultation Questionnaire
Welcome to Your Personal Transformation! Embark on a journey towards holistic wellness and self-improvement. As your dedicated mindset, fitness and nutrition coach, I'm here to guide you through achieving your goals, cultivating a positive mindset, and embracing sustainable lifestyle changes. Let's work together to unlock your full potential, reclaim your confidence, and enjoy the journey to becoming the best version of yourself. Are you ready? Let's begin this transformative adventure!
Personal Details
Your Instagram Profile Name / Handle
Full Name
First Name
Last Name
Age
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Best time to call
Hour Minutes
AM
PM
AM/PM Option
Email
example@example.com
Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
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Current Health Statistics
Weight (lb)
Height (ft/in)
Body Mass Index (BMI)
Appointment
Preferred Day/Days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred Time
Hour Minutes
AM
PM
AM/PM Option
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What are your current fitness and wellness goals?
Do you have any specific health concerns or medical conditions I should be aware of?
How would you describe your current level of physical activity?
Please fill up the table below:
Rows
Yes
No
Occasional
Remarks/Notes
Difficulty of sleeping
Smoking
Drinking alcohol
Pregnant (Female)
Daily exercise
Surgical History
Drinking soda
Drinking caffeinated products
Do you have any allergies? If yes, please list them below:
Are you currently taking any medications? If yes, please identify the medication name and purpose:
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How many days per week are you willing to commit to exercise?
How much time do you have to work out?
What does your typical daily diet look like?
Do you have any dietary restrictions or preferences (e.g., vegan, gluten-free)?
How do you typically handle stress and setbacks?
What are your biggest challenges or obstacles in achieving your fitness and nutrition goals?
What types of physical activities or exercises do you enjoy?
Have you worked with a fitness coach or trainer before? If so, what was your experience?
What are your short-term and long-term fitness goals?
How do you plan your meals, and are you open to meal prepping?
How many meals do you want to eat? 3? 4? 5? 6? More? This is counting small snacks.
What proteins do you like? (Chicken, Beef, Turkey, Egg whites, etc)
What carbohydrates do you like? (Potatoes, rice, oatmeal, tortillas, fruit, veggies, etc)
What kind of fats do you like? (Peanut butter, avocado, nuts, olive oil, etc)
How do you currently track your nutrition and dietary intake?
Are you looking for guidance on supplements?
What days and times are most convenient for you for consultations and check-ins/ follow-ups?
Is there anything else you think is important for me to know?
How did you hear about my services?
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