Fitness / Nutrition Survey
In order for me to be most a more effective Coach, it would help if you honestly responded to the questions below. These responses will be held in confidence between us and are designed to create an action plan to yield the RESULTS you seek.
How do you FEEL about where you are now, health wise, and what the mirror says?
Your busy, on-the-go lifestyle has you grabbing fast food, at least
once per week
3 times per week
most workday lunches
What is your stewardship of your body, goal?
Lose under 10 pounds
Lose 10 - 20 pounds
Lose 20-50 pounds
Lose 50+ pounds
Clean up my eating habits
Generally take better care of myself (eg. care about how I dress, condition my hair, )
Improve my health statistics (BP, Glucose, cholesterol, HR, etc)
Have you tried to accomplish this goal before?
What type of exercise would you most prefer ? (yes, I know you might prefer NONE, but your body requires movement)
military style 'boot camp'
calisthenics (body weight only workouts, push-ups, etc)
High intensity / athletic style
If you accomplished this goal, how would you feel? What would change for you?
Do you feel like you have support for this goal from those closes to you?
Yes. I have family and friends that will cheer me on
Not sure. I never asked for help before
How much water do you drink per day?
None. I hate water
Less than 2 (12 oz) bottles per day
1/2 gallon or more
RE: Exercise, do you
have a gym membership and use it regularly
go for run/walks in the neighborhood at least 3 times per week doing at least 1 mile total
never work out, just too busy, or the weather, or any other distraction that pushes it out of my day
I have physical limitations that make it difficult to exercise
I have a very active, physical day (based on my job or lifestyle)
Re Work: Are you mostly
seated at a desk/computer
lifting items 25lbs+ regularly (like moving patients)
If you have any diagnosed health challenges, you agree to consult with your practictioner to ensure you are cleared to participate in a fitness/nutrition program and what if any contra-indications you should be aware of You also agree to pay attention to your body for any sign of negative stress due to your participation in the program.
I do not have any diagnosed health challenges
Should be Empty: