Hey [wlm_firstname]! Please follow the steps below to get
started with your coach!



On average, how many hours of sleep do you get each night? (required)
 Less than 5 hours 6 hours 7 hours More than 8 hours

What is a normal breakfast you eat in the morning? (required)

What is a normal lunch you eat during the day?

What is a normal dinner you eat at night?

What types of snacks do you eat throughout the day?

What's your main beverage consumed each day?
 Water Fruit Juice Soda Iced Tea Other

What does you day job consist of? Ex: Sitting at a desk.

Briefly describe your specific, short-term goals (within the next 4 weeks) with regards to your body and health.

Briefly describe your specific, long-term goals (beyond 8 weeks) with regards to your body and health.

Have you been diagnosed with any health conditions and/or are you currently taking any medications that we should be aware of? If so, please list and explain.

Are you currently exercising at least three times weekly? If yes, how long have you been consistently doing so?

How would you rate your current level of fitness? Poor, Fair, Average, Good, or Excellent?

Are you 100% willing to commit your FULL effort to this coaching program?

Do you currently have kids under the age of 15?
 Yes No

What is your current weight?

How much weight do you want to lose?