Be Wholehearted Beauty
Nutrition and Lifestyle Questionnaire
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Email *
Name: *
What are your current top 3 health and/or fitness goals? (ex: have more energy, lose toxic fat, put on lean body mass, less stress, better sleep, improve fitness performance.) *
What does a healthy lifestyle look like to you? *
How many meals do you typically eat per day?
Do you typically eat breakfast? If so, what do you have? *
How many meals per day do you buy out on average? *
How many meals per day do you make at home? If so, do you enjoy making those meals? *
Do you have any food allergies? (ex: wheat, gluten, dairy, nuts, fruits, etc) *
Do you sleep well at night? Do you wake up feeling rested?
On average, on a scale of 1-10 how is your energy throughout the day? ( 1 low- 10 high )
On average, how many hours a week do you exercise?
Do you suffer from bloating or digestive issues? *
Do you take any supplements right now? ( ex: vitamins, pre- workout drinks, caffeinated drinks, protein supplements) *
Do you suffer from joint pain and/or inflammation? (ex: knee, back, shoulders, neck ) *
Do you suffer from headaches or migraines? If so, how many times a month on average? *
How many glasses of water do you typically drink per day? *
Do you take any prescription medication? *
On a scale of 1-10 what level of stress do you typically experience during the day? (1 low- 10 high) If so, where does that stress come from? *
Aside from looking and feeling better, why do you want to make changes to your nutrition and fitness lifestyle? *
On a scale of 1-10 how committed are you to making some sustainable healthy lifestyle changes? ( 1 not commited- 10 very committed) *
Would you like to schedule a free 30 min phone consultation ? If so, please mention a few dates/ times you are free over the next week. *
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