1 Min Healthy Habits Wellness WN

Healthy Habits Quiz / This form takes 1 minute to complete

Hey I am Wiktoria a fitness and lifestyle mentor with experience of transforming women’s lives. I’m deeply passionate about helping people and dedicating endless time and energy to each of my clients. If you choose to work with me, expect high standard, Wiki xx
The following application is for an opportunity to work with me 1-1. Application does NOT guarantee admission. Limited spots available. Complete the application only if you’re ready to ditch excuses and truly start prioritizing yourself.
Your Details
Name

First NameLast Name
Phone Number

Area CodePhone Number (please enter valid number)
Instagram Name @
Your Age
What do you do?
Job/profession, student etc.
Where do you live? (city, country)
What appeals to you the most? (select those that apply)
Are you ready to invest to transform your Mind & Body?
On a scale of 1-10, how serious are you about your health and wellbeing?
How far do you feel you currently are from your ideal health/body shape from 1-10?
(1 being far, 10 being close)
What is holding you back the most from achieving these goals?
What is the thing you struggle with, or find the most difficult, when it comes to leading a healthy lifestyle?
Hunger, where to start/what to eat, comfort eating, lack of motivation, being consistent, For example: Lack of education on nutrition, Comfort eating / Snacking, Lack of motivation/consistency, Staying accountable on your journey(Or all of these)
Write what you expect from this Wellness Evaluation and what you need the most help with regarding health, nutrition, or mindset ?
How healthy do you feel on a scale of 1-10?
How active are you on a daily basis?
What do you typically have for breakfast each day?
Do you drink more than 2 litres of water on a daily basis?
Do you know your daily protein target and why this is important?
What do you find bring you the most Stress in your life?
Out of the following options, what appeals to you most?
Would you be interested in watching a short information video on how we can help you achieve results with accountability, by taking part in one of our 10 day focus groups?
Please type the name of the person who sent you this form?

Healthy Habits Quiz / This form takes 1 minute to complete

Your Details