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Question 1 of 8
What is your first and last name?
Question 2 of 8
What is your email? Best way to contact you?
Question 3 of 8
What is your goal(s) and primary focus for the next 3-6 months? Check all that apply:
Fat Loss/Weight Loss
Maintain Weight & Body Recomposition
Surplus or Bulk
Lifestyle Change
Create Healthy Food Habits
Metabolism Repair
Question 4 of 8
What are your struggles? Check all that apply.
Meal Prep
Eating Out
Snacking when not hungry.
Sugar or Carb Cravings
Eating too quickly or too much at meals.
Time for self-care.
Planning meals or workouts.
Emotional or stress eating.
Work or home stress.
Question 5 of 8
Have you tracked your food before?
Yes
No
Question 6 of 8
What types of diets have you been on in the past?
Weight Watchers
Detoxes or eliminations
Zone
A dietician prescribed plan
Jenny Craig
Slim Fast
Intermittent Fasting
Keto
South Beach
Other
Question 7 of 8
Type of Workouts?
Walking/ Steps Only
Running
Peleton/Cycling/Spin
Orange Theory
CrossFit
Strength Training
Mixed Cardio
Power Lifting
Yoga/Pilates/Thai Chi
New Choice
Question 8 of 8
Which describes your level of commitment to taking action?
Not fully ready to commit.
Somewhat ready and motivated.
Feel ready to start making changes.
More than ready for change and taking new actions!