Lima Wellness Pros Online Coaching
Your Blueprint for Optimal Wellness with Coach Tiago Lima
Thank you for choosing me as your health coach! To help me create a personalized plan for you, please take the time to answer the following questions as thoroughly and honestly as possible. Your responses will be kept confidential.
Full Name:
*
First Name
Last Name
Email Address:
*
example@example.com
Preferred Method of communication.
(e.g., email, text, phone call)
Date of Birth
-
Month
-
Day
Year
Date
What are your primary fitness goals?
Please be specific, e.g., lose 15 pounds, run a 5k, increase energy levels, build muscle, improve flexibility
On a scale of 1 to 10 (where 1 is not at all and 10 is extremely important), how important is achieving these goals to you?
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Do you have any specific deadlines or timelines for achieving your goals?
Yes
No
Whats the activity level at you job?
None(seated only)
Moderate(light activity such as walking)
High(Heavy labor, very active)
How would you describe your current level of physical activity?
Sedentary
Lightly active (light exercises or walking)
Moderately active (exercise most days)
Very active (intense exercise daily)
Extra active (very intense exercise & physical job)
On a scale of 1-10, how would you rate your current fitness level?
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
What are your preferred types of workouts or activities? (e.g., strength training, cardio, yoga, Pilates, swimming, hiking)
Do you have access to a gym or any home workout equipment? Please list them.
How many days per week are you realistically able to dedicate to exercise?
How long do you typically spend on each of your training sessions?
Less than 30 minutes
30 - 45 minutes
45 - 60 minutes
60 - 75 minutes
More than 75 minutes
Current Eating Habits:
Describe a typical day of eating for you (breakfast, lunch, dinner, snacks). Please be as detailed as possible.
How would you describe your dietary habits?
Very healthy
Mostly healthy
Occasional junk food
Unhealthy
Do you have any dietary restrictions or allergies? (e.g., vegetarian, vegan, gluten-free, dairy-free)
Yes
No
If yes, please describe:
Do you currently practice intermittent fasting or any special diet?
Yes
No
If yes, please describe:
Do you have any specific nutritional goals or areas you'd like to improve?
Do you typically track your food intake?
Yes
No
If yes, please describe how:
Besides fitness and nutrition, are there any other areas of your health and wellness you would like to focus on? (e.g., stress management, sleep hygiene, mindfulness, hydration)
Health History & Current Health Issues:
Do you experience any recurring pain or discomfort?
Yes
No
If yes, please specify the areas:
Do you have any past injuries or physical limitations that might affect your ability to exercise? (e.g., back pain, knee problems, shoulder injuries) Please be specific.
How many hours do you typically sleep each night?
On a scale of 1-10, how would you rate your daily energy levels?
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Have you been diagnosed with any health condition in the last five years?
Yes
No
If yes, please specify:
What, if any, medications or supplements do you regularly take?
Have you previously invested in fitness courses, coaches, or products?
Yes
No
If yes, what were they and were they effective?
Do you currently have a support system for your fitness journey? (e.g. workout partner, supportive family)
Yes
No
Is there any other information about your health or fitness you think we should know?
Submit
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