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Help me, help you get the most out of our upcoming private session...
Please set aside 2-3 minutes to complete this questionnaire
Your Name:
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Your current weight
Nutrition Update
Do you currently skip breakfast, lunch, and/or dinner?
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Select all that applies:
Do you currently skip breakfast, lunch, and/or dinner?
No, I rarely skip meals on purpose
Yes, I skip breakfast almost every day
Yes, I skip lunch almost every day
Yes, I skip dinner almost every day
How many "cheat" meals and/or snacks have you had in the last two weeks?
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How many "cheat" meals and/or snacks have you had in the last two weeks?
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3
None
3 or more cheat meals
Do you snack?
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Select all that applies:
Do you snack?
No, I rarely snack
Yes, I snack between breakfast and lunch
Yes, I snack between lunch and dinner
Yes, I snack in the evening, after dinner
Yes, I snack a lot at various times
Select all that applies:
Is there anything else about food or nutrition you think we should discuss?
Exercise & Physical Activity Update
How many resistance training sessions are you doing per week on average?
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How many resistance training sessions are you doing per week on average?
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1
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3
None
3 or more sessions
How challenging do you find your workouts while you're doing them?
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How challenging do you find your workouts while you're doing them?
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Not challenging at all
More than I can handle
Any other comments/questions about resistance training or physical activity?
Self-Assessment
Do you anticipate any specific challenges over the next
4-6 weeks
, anything that could make it more challenging to eat well, exercise, and/or engage in behaviors that serve your goals?
How would you rate your day-to-day energy levels?
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How would you rate your day-to-day energy levels?
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10
Never enough
Ideal
How would you rate your stress and/or anxiety levels?
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How would you rate your stress and/or anxiety levels?
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Low
High
Is there anything else you would like to discuss during our 1-on-1?
Submit
