Clients Assessment & Readiness Form
Please fill this form below to enable us work better with you. thank you.
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Name *
Age *
Mobile Phone Number
What do you want? in general what are your goals? Tick your goals
Out of all these concerns, Which ones feel most important
What do you expect from me as your coach? *
Are you prepared to work towards your goal? *
What do you want to change?
Have you tried anything in the past to change your habits health, eating and or your body?
Which of those things worked well for you?
Which of them didn't work for you?
If you were to consider making changes to your habits, health, eating and or your body, what might those be?
Until now, what has blocked you or held you back from changing these things?
Right Now, how would you rank your overall eating Nutritional habit
Horrible
Awesome
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why?
What kind of sports/ exercise do you enjoy?
Are you ready to include some?
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How is your stress and recovery?
Given all the demands of your life, what is your typical stress level on an average day
No stress
Extreme
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On an average how many hours per night do you sleep
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How do you normally cope with stress
How ready, willing and able are you to change?
Not at all
Completely
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How willing are you to change your behaviors and habit?
Not at all
completely
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How able are you to change your behavior and habits
What should I do if you stopped co-operating or started losing focus? What do you grant me permission to do to call you back on track? *
Who is your physical support system (state your  RELATIONSHIP with them eg husband, grownup children, house manger etc), whom we can call to check on you if you become incommunicado without known cause
Give NAME & PHONE NUMBER
Important: we only call them when absolutely needed
 *
Disclaimer
Please recognize that it is your responsibility to work with your healthcare provider during and after seeking nutrition or fitness consultation and coaching. Any information provided is not to be followed without proper approval of your doctor, if you choose to use this information without such approval, you agree to accept full responsibility for your decision.
Privacy
Please note that ALL information provided here is confidential and is strictly for use to serve you best as we understand your health goals and needs and to track your progress. We do not sell client data. Rest assured.
Click to Agree *
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