High Performance Coaching
On a scale of 1-10 how do you feel your overall health is right now?
On a scale of 1-10 how would you rate your overall physical performance in life?
Please tell me what your ultimate goal in working with me as your coach. What will your life, goals, fitness and health feel and look like?
Please describe your current day to day schedule? What are your routines, habits, health, fitness, and professional day to day routines?
Why now? Why is this the right time for you to reach your goals?
Please tell me a little bit about your day to day self care. How do you take care of you?
Please tell me a little bit about your current family or close community support system?
Do you currently take any medications? If so please tell me about them and any other nutritional supplements you take.
Are you ready to fully commit to reaching your goals and empower yourself committed action?
Is there anything else you would like me to know?
Please tell me about any self sabotaging behavior.
Who is your emergency contact?
Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?
Are you allergic to any medications or foods?
Have you ever had pain in your chest while exercising?
On a scale of 1-10 how would you rate your physical overall health
Have you ever experienced loss of balance or dizziness while exercising?
Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, anorexia, bulimia, anemia, epilepsy, respiratory ailments, back problems, etc.)?
Type option 4
Do you take any medications, either prescription or nonprescription, on a regular basis? Yes/No What is medication for?_
Are you pregnant now or have given birth within the last 6 months? Have you had a recent surgery?
Pease list any foods you dislike or will not eat as well as your favorite foods.
Have you ever suffered from a diagnosed mental illness?
Have you ever suffered from an eating disorder? If so please explain in detail.
Do you drink coffee daily?
yes 1-2 cups
yes 2 or more
Do you drink alcohol?
yes 1-2 drinks per week
yes 3-4 drinks per week
yes 5 or more drinks per week
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