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Please take a moment to fill out the form.
Full Name
*
Email
*
Height (in cms)
*
Current Weight (in Kgs)
*
Do you have any medical conditions you wish to disclose? (I.E. diabetes, hypothyroid, high cholesterol, etc) *
*
What ‘s the main goal that brings you to nutrition coaching ?
*
Have you done any fad diets/what have you tried in the past? *
How many calories on average are you eating per day?(if not tracking, provide a rough estimate) *
How would you rate your protein intake? *
How would you rate your food quality? *
Do you find yourself consuming large amounts of coffee or energy drinks to get through the day? *
How would you rate your daily energy levels? *
How would you rate your daily stress levels? *
Do you find that you are able to cope with and manage your day to day stress? *
If you answered yes to the previous question, how do you cope with day to day stress (ex. walks alone, meditation, reading, watching TV) *
On average, how many hours of sleep do you get each night? *
How would you rate the quality of your sleep? *
Do you have a sleep routine (I.e. go to bed and wake up at generally the same time each day) *
How active are you? *
This assessment is not about coaching but are you interested in hearing more about 1 on 1 coaching? *
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