New Client Assessment

To provide you with the best possible support, I kindly ask that you answer the following questions with honesty and as much detail as you're comfortable sharing. The more I understand your current habits, preferences, and goals, the better I can tailor my guidance to your needs. Your responses are always kept confidential and without judgment

First name

Last name

Phone

Birthday

Month

Day

Year

Address

Age

Weight

Height

What do YOU believe might be holding you back from optimal health?

What made you reach out for guidance?

Tell me a little bit about your health journey. (diets you've followed, exercise, etc)

What has helped you stay accountable in the past?

What are you currently doing for exercise? Do you have a gym membership?

Are there any food or beverages you struggle to avoid?

How many meals a day are you eating on average?

How are your bowels?

Tell me about how you sleep.

Have you been stressed / anxious recently?

How to you manage stress currently?

List foods that don't make you feel too good (intolerances, allergies..)

List foods you know make you feel good.

Are you currently taking any nutritional supplements? If so, tell me what you're taking, the dosage and brand name.

Are you currently on any medications?

Have you been diagnosed with any conditions?

Do any health conditions run in your family? (what condition and who)

How much water are you currently drinking?

What is your energy like? Tell me when you have the most to least amount of energy and around what time in the day.

What grocery stores do you prefer shopping at?

Does stress/emotions play a role in your appetite? Elaborate.

Does stress play a role in your appetite? Elaborate.

Do you have a budget for grocery shopping?

Do you eat with your family? Do you eat alone? elaborate.

How hopeful are you to enhancing your lifestyle?

How do you learn best?

What traits would your IDEAL coach have?

What is your love language?

Tell me about your confidence and self-esteem.

What days/times are best for coaching?

Tell me what and how much you eat during the week and weekend. Start from breakfast and don't leave out beverages.

**IMPORTANT** Track 3 days of your intake - preferably 2 weekdays, and 1 weekend, day. Bring the diary to your kick-off session!