30MinuteMummy InnerFit Form
This form gives us lots of information to get you started with your Fitness Mentor!
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What is your main goal for your journey on the InnerFitGo! Program? *
What Is Your Name?
What is your email address and phone number?
Why Did You Join The InnerFit Program? (Choose All That Apply)
What is your age?
What is Your Height (cm)?
What Is Your Weight (kg)?
How Active Are You, Day-to-Day? (i.e. not including dedicated exercise)
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Tell Us About Any Dedicated Exercise That You Do... (walking, weight lifting, yoga, running, gym classes, etc.,)
How Often Do You Do Dedicated Exercise?
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Would You Like An Exercise Program Written For You?
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How Much Sleep Do You Get Each Night (on average)?
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How Fast Do You Fall Asleep?
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Describe The Quality Of Your Sleep
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What time do you normally go to bed?  And what time do you normally get up? *
How Much Water Do You Drink Each Day?
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Would You Like a Prescribed Food Plan Made For You?
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What Sort Of Cravings Do You Get?
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Do You Have Any Food Allergies or Intolerances?
Do you have any medical conditions that could impact your wellness journey? Or are you on any medications?
List Your Top 5-10 Favourite Foods
List Foods You Can Not and Will Not Eat
Do You Do Anything Particular With Your Eating Now?
What Do You Normally Have For The First Meal Of The Day?
What Do You Normally Have For Lunch?
What Do You Normally Have For Dinner?
Describe Your Typical Snack Between Meals.
Do You Use A Fitness Tracker Of Some Description?
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What is your main goal(s) for the next 8 weeks? *
How committed are you to completing this program?
Somewhat
Extremely! Bring it on!
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Can you identify any factors that are going to be a struggle for you?  Limiting beliefs, reasons you haven't succeeded in the past?
Disclaimer
 I understand that by completing and submitting this form that the team at 30minutemummy will do their best to help
me based on the knowledge that they have. I acknowledge that I am responsible for my own safety, and that I will not
attempt any exercises out of my limits. 30minutemummy cannot be held liable for any injuries I incur as a result of
exercising.
 I have included any and all information that my mentor might need to write an appropriate program for me, and that I
have not included any misleading information.
 I agree to chat with my mentor, either online or in person, at least twice a week to discuss my progress and request any
changes if needed. I also agree to write a before, during and after reflection on my experience and allow these
reflections to go on social media, with or without photos. I understand that my mentor will use these reflections and
our chats to better their own practice, and they may use these for advertising on social media.
 I agree to keep any exercise programs and food plans to myself, and not share them with other people under any
circumstance. The information provided to me by my mentor is intellectual property of 30minutemummy and the
sharing of information may result in termination of this program or legal ramifications.
 I understand that the team at 30minutemummy in itself has limitations, and that they are not yet registered or accredited dietitians, but rather are nutrition coaches. While they give me advice, it is my responsibility to ensure that food and exercises are within the ranges of my own health, including but not limited to food allergies and intolerances.
I acknowledge that the team at 30minutemummy will do what they can to help me, and I cannot hold them liable for a lack of results.
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