TJTemperTraining Client Health & Goals Assessment

TJTemperTraining Client Health & Goals Assessment

Your answers help me understand where you are today so I can guide you toward feeling, performing, and living at your best.
Website: www.tjtempertraining.com
Phone: 614-716-9185
Basic Info
Full Name*

First NameLast Name
Age*
Birthday*

MonthDayYear
Date
Occupation
Current Weight (lbs)*
Goal Weight (lbs)*
Activity Level*

LowModerateHigh
SECTION 1 – Your Top Priorities
What are your top 3 outcomes you want to achieve?*

Fat lossEnergyCravingsSleepRecoveryAppearanceAgingOther
How important are these outcomes to you?*

1

2

3

4

5

1 is Not at all, 5 is Very Important
SECTION 2 – Weight & Metabolism
What is your biggest challenge with weight management?*

Struggling to loseStruggling to maintainFluctuating weightOther
How often do you experience weight creep (gradual weight gain)?*

NeverRarelySometimesOften
Do you struggle with food noise (constant thoughts about food)?*

NeverOccasionallyFrequently
Have you regained weight after losing it?*

NoYes, onceYes, multiple times
Have you tried GLP1 medications?*

YesNo
SECTION 3 – Energy & Mood
How often do you feel fatigued?*

NeverOccasionallyFrequently
Do you experience brain fog?*

NeverOccasionallyFrequently
How often do you feel stressed?*

RarelySometimesOften
SECTION 4 – Recovery
Do you experience slow recovery after exercise?*

NeverSometimesOften
Do you experience joint pain?*

NeverOccasionallyFrequently
Any past injuries?*
SECTION 5 – Sleep & Immune
How would you rate your sleep quality?*

ExcellentGoodFairPoor
How often do you get sick?*

RarelyOccasionallyFrequently
Are you exposed to toxins (e.g., chemicals, smoke, pollution) regularly?*

YesNo
SECTION 6 – Aging
Are you concerned about aging?*

Not at allA littleSomewhatVery
Have you noticed changes in appearance due to aging?*

NoSomeSignificant
Are you interested in longevity and healthy aging?*

YesNo
SECTION 7 – Microdosing Fit
Which best describes your current weight situation?*

StableSlowly increasingSlowly decreasingRapidly increasingRapidly decreasing
Which has a bigger impact for you: hormones or habits?*

HormonesHabitsBoth equallyNot sure
Do you have any microdose preferences or experiences?*
SECTION 8 – Medical
Do you have any restrictions for GLP1 medications?*

YesNo
If yes, please explain your GLP1 restrictions.*
Please select any medical diagnoses you have received.*

DiabetesThyroid disorderHypertensionHeart diseaseAutoimmuneOther
Are you currently pregnant?*

YesNoPrefer not to say
Please provide any additional health notes.*
List any medications you are currently taking.*
Final
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
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TJTemperTraining Client Health & Goals Assessment

Basic Info

SECTION 1 – Your Top Priorities

SECTION 2 – Weight & Metabolism

SECTION 3 – Energy & Mood

SECTION 4 – Recovery

SECTION 5 – Sleep & Immune

SECTION 6 – Aging

SECTION 7 – Microdosing Fit

SECTION 8 – Medical

Final