Welcome Wellness Evalutation

WELCOME WELLNESS EVALUATION

Date

First Name

Last Name

Phone

Address

City, State

Zip Code

Age

Birthday

Height

Weight

Waist Measurement (inches)

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Front

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Side 1

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Side 2

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Back

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Goals:

Examples:

Why are you here? And what would you like to achieve from this program?

Where do you see yourself in 6 months in regards to your life?

Do you have an ideal weight? Attach inspiration picture if you'd like...

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Who is going to help you achieve these goals?

If I can show you a way to get everything that you are looking for would you be happy to refer your friends and family to one of my programs?

Nutrition Info:
(the more details the better)

Any food allergies?

Any food limitations/religious/preferences/sensitivity, etc...

What did you have as food and drink yesterday from morning to evening?

Morning

AM Snack

Lunch

PM Snack

Dinner

Late Night

Do you take any supplements? If so, which ones and how often?

Coffee - how many cups a day?

Juice or Soda - how many glasses a day?

Water - how many glasses a day?

Cravings - sweet or sour? What do you crave the most and what time of day?

What time do you feel most hungry? What do your normally eat?

Do you snack late at night? If so, what do you snack on?

Do you wake up at night and eat?

Sleep:

When do you go to bed?

When do you wake up?

Hours of sleep in total?

Do you sleep all night? If not, what wakes you up? How many times?

What time do you feel most tired?

What do you do when you feel this way?

Do you take naps?

Workout:

Do you workout? If yes, what kind of workout?

What time during the day do you workout? How long is each workout?

On a scale of 1-10 how intense are your workouts? (1 being light, 10 being very intense)

If you don't workout - do you wish to start with help?

Recovery:

How do you help your body recover?

Do you need help learning about recovery methods?

Mindset:

Are you open to learn new things and to apply them?

Do you read any books? If so, which ones?

Do you meditate? How long and how often?

Stress level (from 1-10)

What are the 3 main reasons to cause stress in your life?

Are you willing to give yourself permission to change, feel insanely amazing, and transform?

Welcome to my community! If you are ready to change, I'm committed to showing you the way. Let's do it!

WELCOME WELLNESS EVALUATION

Upload Pictures:

Goals:

Examples:

Nutrition Info:
(the more details the better)

Sleep:

Workout:

Recovery:

Mindset:

This program is not some far off dream for the chosen few.

All you need is the roadmap (which I am handing you) and the choice to commit. In only 6 weeks, you can look back and realize you were the type of woman who was competent all along, she was just waiting to be unleashed.

THERE'S A SAYING:
"SUN'S OUT, BUN'S OUT"

WELCOME WELLNESS EVALUATION

Upload Pictures:

Goals:

Examples:

Nutrition Info: (the more details the better)

Sleep:

Workout:

Recovery:

Mindset:

This program is not some far off dream for the chosen few. All you need is the roadmap (which I am handing you) and the choice to commit. In only 6 weeks, you can look back and realize you were the type of woman who was competent all along, she was just waiting to be unleashed.

THERE'S A SAYING: "SUN'S OUT, BUN'S OUT"

Nutrition Info:
(the more details the better)

This program is not some far off dream for the chosen few.

All you need is the roadmap (which I am handing you) and the choice to commit. In only 6 weeks, you can look back and realize you were the type of woman who was competent all along, she was just waiting to be unleashed.

THERE'S A SAYING:
"SUN'S OUT, BUN'S OUT"