METABOLIC ASSESSMENT

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Full Name *

Email *

Height *

Current Weight *

Gender *

Have you had your bloodwork done anytime in the past year? *

Do you have any medical conditions you wish to disclose? (I.E. diabetes, hypothyroid, high cholesterol, etc) *

Goal Review Section

What is your primary fitness/health goal? *

What do you feel like are your biggest barriers or challenges to success? *

How would you rate your support system (family, friends, etc.) for reaching this goal? *

If female, do you have a regular cycle (you can explain in as much or as little detail as you're comfortable with)

If female, are you peri/menopausal?

If yes, do you have an symptoms that you are dealing with?

Have you done any fad diets/what have you tried in the past? *

How many calories on average are you eating per day?(if not tracking, how many meals and snacks/day) *

How would you rate your protein intake? *

How would you rate your fiber (fruits, veggies, nuts, etc.) intake? *

How would you rate your food quality? *

Do you find yourself consuming large amounts of coffee or energy drinks to get through the day? *

How would you rate your daily energy levels? *

How would you rate your daily stress levels? *

Do you find that you are able to cope with and manage your day to day stress? *

If you answered yes to the previous question, how do you cope with day to day stress (ex. walks alone, meditation, reading, watching TV) *

On average, how many hours of sleep do you get each night? *

How would you rate the quality of your sleep? *

Do you have a sleep routine (I.e. go to bed and wake up at generally the same time each day) *

How active are you? *

How would you describe your fitness routine? *

This assessment is not about coaching but are you interested in hearing more about 1 on 1 coaching? *