Pre-Coaching Questionnaire
Thank you for taking the time to answer these questions. This just helps me understand where you are and I will be in contact with you after I review.
1. Would you consider your current health status to be poor?
Yes
No
2. Would you consider yourself to be strong minded?
Please Select
Yes
No
Sometimes
3. Do you adjust well to change?
Yes
No
4. Are you willing to invest in your health right now?
Yes
No
5. Would you consider yourself to be open-minded?
Please Select
Yes
No
6. Are you willing to be committed for sake of your health?
Please Select
Yes
No
Maybe
7. Are you a picky eater?
Please Select
Yes
No
Depends
8. Are you ready to start your health journey today?
Please Select
Yes
No
Unsure
9. What are your main concerns when thinking about diet/lifestyle changes?
10. How much would you be willing to invest in your health?
11. Why not stay where you are now? (Affecting every day life, relationships, etc.)
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Submit
Should be Empty: