Take The First Steps In Reaching Your Goals!

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Take The First Steps In Reaching Your Goals!

Take The First Steps In Reaching Your Goals!

By filling out and submitting this form I will be able to provide you with 3-5 action items that I believe can help you reach your goal and overcome your biggest obstacle. This should just take 5 minutes to fill out and could be a game changer in getting you heading in the right direction!

23Questions

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
How old are you?* This field is required.
4
What is your biological sex?* This field is required.
5
How tall are you (in inches)?* This field is required.
in inches
6
What is your current weight (in pounds)?* This field is required.
7
How much time a day do you spend sitting on average?* This field is required.
1-3 Hours
3-6 Hours
6-9 Hours
More Than 9 Hours
8
How many hour of sleep do you get a night on average?* This field is required.
9
How many days a week do you exercise on average?* This field is required.
0
1
2
3
4
5
6
7
10
How long does your exercise session last on average?* This field is required.
Less than 30 minutes
30-45 minutes
45-60 minutes
60 minutes or more
11
Describe how much movement you get in the day.This could be walking, doing house chores, gardening, anything you do that is physical activity but not formal exercise.
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Large
Normal
Small
Ok
Ok
12
How do you feel when you're stressed on a normal day?
Absolutely Horrible
AMAZING!
Row 0, Column 0
Absolutely Horrible
AMAZING!
Row 0, Column 0
13
How many meals a day do you eat on average?* This field is required.
1
2
3
4
5
6+
14
How many snacks a day do you eat on average?* This field is required.
0
1
2
3
4
5
6+
15
How much water do you drink a day on average?* This field is required.
Less than 8 oz
8-16 oz
16-32 oz
32-64 oz
64-128 oz
More than 128 oz
I have no idea
16
How often do you eat fruits and vegetables?* This field is required.
Never
Some meals
Most meals
Every meal
17
On average how much alcohol do you drink a week?* This field is required.A drink would be one shot, one 8oz beer, or 5 oz of wine.
0 drinks
1-2 drinks
2-4 drinks
5-7 drinks
7 or more drinks
18
What types of exercise do you like the most?
19
Do you track your food by weighing and measuring it?* This field is required.
YESNO
20
Please let me know about any chronic health conditions you have.* This field is required.
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Large
Normal
Small
Ok
Ok
21
What health goals would you like to achieve in the next 6-12 months?* This field is required.
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Large
Normal
Small
Ok
Ok
22
What have you tried in the past and why hasn't it worked for you? What's stopping you from hitting your goal.* This field is required.
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Large
Normal
Small
Ok
Ok
23
Would you be interested in one on one coaching to help you reach your goal(s)?* This field is required.
YESNO
Should be Empty:

Question Label

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