New Client Survey
Name
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First Name
Last Name
Email
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example@example.com
Please identify specifically how you found us.(For example, the name of the podcast or the name of the person who referred you.)
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What are your main goals for seeking nutrition/exercise counseling with the Body Bar Studio (select all that apply)?
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Lose some weight
Get leaner
Get stronger
Increase energy
Lower bloating
Improve sleep
Eat more balanced
Consume less sugar
Have more regular bowl movements
“I’m not feeling as good as I could”
Do you have any known health or medical conditions or diagnosis that we should know about in helping you to find the best care? If yes, please explain.
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What have you tried so far to address your goal? (Diets, workouts, modalities, etc.)
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Please list any dietary sensitivities.
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Which of the following items are currently in your diet in any amount: (select all that apply)
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Dairy
Processed foods
Sweet & desserts
Sodas
Sweetners
Gluten
What percentage of your meals are currently home cooked, (0-100%)?
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How much time are you willing to commit to reach your goal?
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1 month (short-term reset)
3 months (jump-start transformation)
6 months (sustainable body and lifestyle change)
12 months (long-term transformation & maintenance)
What level of financial investment are you comfortable making to achieve your transformation?
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I want to get started with the minimum investment
I’m comfortable investing moderately for proven results
I’m fully committed and ready to invest at the highest level for the best results
We are committed to working with individuals who are dedicated to their health andready to receive support on their individualized journey to health and healing. We're uniquely poised to uncover and unlock the evolving protocol that will deliver the results you've been seeking. In two or three sentences, tell us something about yourself and/or your health history that will help us get to know you before we take any further steps to dig more deeply into the details of your concerns. When you're done, be sure to hit the orange button to schedule your First Strategy Session (it’s already been done for you). I look forward to our next session on your journey to feeling GREAT!
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