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EBM Fitness Solutions Nutrition Coaching Questionnaire.
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詳細
* 必須の質問です
Name
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Contact information
Phone number, email or any way you prefer to be contacted.
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What are your goals?
Please check all that apply to you.
Lose weight/body fat
Gain muscle/add weight
Maintain weight
Improve physical fitness
Look better
Feel better
Have more energy
Get control of your eating habits
Improve athletic performance
If your goal was not listed, please list it below.
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Why are your goals important to you?
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Please list all of your concerns about your health, eating habits, fitness, and/or body.
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Out of all of the above concerns, which ones feel most important/urgent? Include why they are the most urgent.
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Have you tried anything in the past to change your habits, your health, your eating, and / or your body? If so, what?
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Which of those things worked well for you? (Even if you might not be doing it right now.)
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Right now, how would you rank your overall eating/nutrition habits?
Horrible
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Awesome
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Why did you rank your habits the way you did?
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How long after you wake up do you wait until you eat something?
Although delicious, coffee is not food. This question is looking for how soon after waking you actually eat something.
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Do you currently use any supplements?
Could be vitamins, minerals, protein powder, bars, omega-3's or similar products.
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Do you have any digestive disorders?
*
This includes, but is not limited to: Celiac, Crohn's, lactose intolerance, reflux or ulcers.
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Who lives with you?
Spouse/partner
Roommate(s)
Child(ren)
Pet(s)
Other family members
その他:
Who does most of the grocery shopping in your household?
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Who does most of the cooking in your household?
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Right now, how much do the people and things around you support health, fitness, and/or behavior change?
Not at all
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Completely
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On a scale from 1-10, how would you rank your overall health?
Terrible
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Awesome
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On a scale from 1-10, how do you feel about your schedule, time use, and overall busyness?
My life is panicked and stressed
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My life is perfectly calm and relaxed
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STRESS and RECOVERY
Given all the demands of your life, what is your typical stress level on an average day?
No stress
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Extreme stress
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On average, how many hours do you sleep each night?
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How do you normally cope with stress?
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READING, WILLING and ABLE to change.
How READY are you to change your behaviors and habits?
Not at all
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Completely
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How WILLING are you to change your behaviors and habits?
Not at all
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Completely
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How ABLE are you to change your behaviors and habits?
Not at all
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Completely
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Please list all obstacles or constraints to making and sticking with nutritional changes.
Maybe you have picky kiddos who don't eat anything other than mac n cheese. Maybe you associate nutrition plans with starvation. Maybe you have little time. These answers will be key to making the necessary changes.
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Please use this space to add any additional information that was not covered. If you are good to go then you are good to go.
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送信
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