Goals & Lifestyle Form
Name
*
First Name
Last Name
Age
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Scale Weight
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Height
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BF % if you know it
Email
*
example@example.com
What is your reason for reaching out? What are you struggling with?
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Why are you reaching out now? sick of being stuck, event coming up etc?
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6 months from now, you're in a completely differnet
What do you do for work?
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Do you have any injuries? (this will need to be cleared by a Professional)
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How many steps do you do per day? (on avg)
How Many Calories do you eat per day (7 Day Average - if known)?
What is your current Macro Breakdown (if you know - look at MyFitnessPal)
Do you tend to eat more calories on the weekend?
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In the past 12-24 Weeks have you been in a deficit, at maintenance or above maintenance calories?
Do you have any history with Eating Disorders or anything we should know about?
How many times have you dieted this past year?
Do you drink alcohol?
On the Weekends
A few times per week
Only for parties and occasions
Don't drink alcohol
How often do you eat out / order in takeaway or uber eats? incl weekends
1 x per week
2 x per week
3+ x per week
Very Rarely
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Goals
What is your Short Term Goal - 3 months? Long Term Goal 6+ months?
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Why are these Goals important to you?
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Aesthetically, what is your MAIN FOCUS?
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FAT LOSS
MAINTENANCE
REVERSE DIETING
BUILDING MUSCLE MASS
Performance or strength based goal?
How Important are these goals to you?
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TOP Priority, I will achieve my goals
Pretty Important but not my number 1 focus right now
Moderately important, would be nice to achieve them but other things are priority right now
Not bothered if I achieve them or not
How much support do you need?
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Weekly Checkins, Zoom Calls, Meal Plan(optional) & Daily Voice Message Support - This is for people who want a BIG change especially for Fat Loss over 8+kgs, never tracked before or disordered eating patterns/yoyo dieting, gut issues or hormonal issues
Fortnightly Written Checkins, Macros & Flexible Dieting which is slightly less support for those who have some experience in tracking their food
What do you think you will need help with the most in order to reach your goals? Accountability, mindset, support around nutrition and social events, help with training etc
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Have you gotten help from a coach or nutritionist before? If yes, How was that experience? If No, what has stopped you?
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Do you have any limiting beliefs? What is going to be the biggest obstacle that you think will get in the way from you achieving your goals?
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Are you experiencing high stress?
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Emotionally
Physically
Financially
Stress Levels are okay
How many hours sleep do you get per night (on avg)?
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Are Your Current Energy Levels
Low
Moderate
High
Are Your Current Hunger Levels
Low
Moderate
High
Do your currently have a regular menstrual cycle? or on hormonal contraception?
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Are you Interested or Invested?!
We invest a lot of time, energy and passion into helping our clients so like to ensure we are an energetic match and working with people who are ready to make a BIG Change and see the RESULTS they've not been able to achieve themselves or with previous coaches
Are you ready to invest time, effort and money into achieving your goals?
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Yes
No
How much are you prepared to invest each week into personalised training and nutrition coaching to reach your goals?
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$25–$50 per week – I’m curious to trial online coaching with low pressure and committment
$50–$80 per week – I’m committed and want consistent support
$80–$100 per week – I take my results seriously and want a high level of guidance
$100-$150 per week – I’m all in and want a premium, tailored experience with daily access to my nutritionists and coaches for motivation, support, and guaranteed results
If you have no doubt the program is the perfect fit for your needs to get results, how comfortable are you with investing in yourself financially?
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I am comfortable with financially investing in myself and see this as a priority
I can make some adjustments to accommodate the investment but would need a payment plan
I am currently unable to make any significant financial committments
I am not comfortable with investing financially in myself unless its a very small investment
What is the cost of not making a change? Are you wiling to still be in this same place in 6,8,12 months from now?
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Yes, I'm happy where I'm at
No, I will make a change and be proud in 6-12 months
I can do it myself
So we know when to contact you - How Ready are you to start seeing Results?
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ASAP, I'm Ready & Committed - lets go!
In 1-2 weeks, I'm busy
Not Sure yet
What form of communication would you prefer us to contact you to discuss options?
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Call me
Email me
Text me
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Submit
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