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Let’s Talk About
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Please fill out this questionnaire to begin your Holistic HEALTH Journey
Holistic Health Coaching Questionnaire
Name
*
Name
First
First
Last
Last
Email
*
Phone
*
NUTRITIONAL DETAILS - What diets and/or styles of eating have your practiced before?
*
IIFYM
Strictly Clean Eating/Meal Plan
Vegetarian
Vegan
Ketogenic
Paleo
Cheat Meals
Atkins
Weight Watchers
Other:
With your current nutritional habits have you been gaining, losing or maintaining weight?
*
Gaining
Losing
Maintaining
How long have you been on your current nutritional plan?
*
Are you familiar with tracking Macros?
*
Yes
No
What is your current average daily caloric intake?
*
Break down in Carbohydrates, Protein & Fat
MEDICAL DETAILS | Do you have any injuries or physical limitations?
*
Answer with YES/NO (If YES, please list above)
Are you currently taking any prescribed medication?
*
Answer with YES/NO (If YES, please list above)
Do you have ongoing health issues, food allergies or intolerances?
*
Answer with YES/NO (If YES, please list above)
Do you have any history of any eating disorders or extreme dietary restriction?
*
Answer with YES/NO (If YES, please give me as much detail as possible about your history of dieting, weight loss/regain, number of times you've tried to diet, how recently and for how ling ect)
TRAINING DETAILS | Do you strength train?
*
Answer with YES/NO (If YES, please list how many times a week and duration)
How many hours of cardio do you perform on average per week? (Including Walking)
*
Please list a number hours
What days of the week are you able to train and how long for?
*
List Days (e.g Monday, Tuesday...)
What sounds worse?
*
Eating Less Food
Performing More Cardio
How active is you Job?
*
Where do you workout?
*
Gym
Home
Other
None
What are your expectations of me and my role as a coach?
*
How did you hear about us?
*
Website
Instagram
Facebook
Signage
Word of Mouth
Referral
Other
Submit
If you are human, leave this field blank.
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ABOUT
Meet The Maven
SERVICES
Intuitive Guidance
Love & Relationship Guidance
Sacred Tarot Readings
Goddess Embodiment Rituals
Soul Sessions
1:1 Coaching
COACHING
Holistic Health Coaching Questionnaire
Life Coaching Questionnaire
CONNECT
ABOUT
Meet The Maven
SERVICES
Intuitive Guidance
Love & Relationship Guidance
Sacred Tarot Readings
Goddess Embodiment Rituals
Soul Sessions
1:1 Coaching
COACHING
Holistic Health Coaching Questionnaire
Life Coaching Questionnaire
CONNECT