initial assessment

By learning more about you, your lifestyle and your habits, I can take better care of you and make sure coaching is a good fit for your individual goals and needs.

Tell me about yourself

Name and surname *

Date of birth *

Sex *MaleFemaleOther

Height in cm (optional)

Weight in kg (optional)

Staying in touch

Email address *

Cell phone number *

How do you want me to contact you initially? *EmailWhatsAppSMS

Emergency contact name *

Emergency contact phone number *

What do you want to change?

How, specifically, would you like your habits, your health, your eating and/or your body to be different? *

Out of all the changes you'd like to make, which ones feel most important/urgent? *

Have you tried anything in the past (or recently) to change your habits, your health, your eating and/or your body? If so, what? *

Which of those things worked for you, and why? *

Which of those things didn't work well for you and why not? *

If you were to consider making more changes to your habits, your health, your eating and/or your body, what might those be? *

Until now, what has blocked you or held you back from changing these things? *

What's your health like?

Have you been diagnosed (currently or in the past) with any significant medical condition(s) and/or injuries? *YesNo

Right now, do you have any specific health concerns, such as illness, pain and/or injuries? *YesNo

Right now, are you taking any medications, either over-the-counter or prescription? *YesNo

On a scale of one to ten, one being the worst and ten being awesome, how would you rate your health right now? *

Why? *

How are you spending your time?

In an average week, how many hours do you spend in paid employment? *

In an average week, how many hours do you spend at school or doing school work? *

In an average week, how many hours do you spend travelling and/or commuting? *

In an average week, how many hours do you spend taking care of others? *

In an average week, how many hours do you spend doing other unpaid work such housework and errands? *

In an average week, how many hours do you spend volunteering? *

On a scale of one to ten, how do you feel about your schedule, time use, and overall busyness? *

How is your stress and recovery?

Given all the demands of your life, what is your typical stress level on an average day? Rate this on a scale of one to ten, where one is no stress and ten is extreme stress. *

How do you normally cope with your stress? *

How ready, willing and able are you to change? (On a scale of one to ten, where one is not at all and ten is completely.)

How READY are you to change your behaviours and habits? *

How WILLING are you to change your behaviours and habits? *

How ABLE are you to change your behaviours and habits? *

What do you expect?

What do you expect from me as your coach? *

What are you prepared to do to work towards your goals? *