Dad Bod Health Private Coaching Questionnaire

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Full Name *

Age *

Best email to reach you? *

What is your occupation? *

What are your work hours? *

How many days per week realistically are you able to work? *

2-3 days

3-4 days

4-5 days

Whatever is required

Other:

On a scale of 1-10, with 10 being the most ready, how ready are you to make this transformation? *

I'm thinking about it

I WANT this!

What is your major motivation behind wanting to get healthy and make this transformation? *

Is your spouse or significant other supportive of this transformation? *

Yes

Has your doctor mentioned if you have any specific conditions or health risks? *

Yes

If you answered yes to the question above, what conditions may limit your ability to perform certain exercises or work out on a regular basis?

Place N/A if not applicable

Are you currently on any medications? *

Yes

If you answered yes to the question above, please list your medications below.

Place N/A if not applicable

Do you have any food allergies or food restrictions? *

Yes

If you answered yes to the question above, please list those below?

Place N/A if not applicable

Have you ever invested in your health in order to help you reach your goals? *

Yes

If so, please describe the program and your overall results? *

Submit

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