Welcome! This is a questionnaire that allows me to get to know you better so I can provide you with a custom coaching process and program. Let’s work together What help are you looking for most on your fitness journey? Accountability Structure Mindset What's inspiring you today to start this fitness journey? Please be detailed What is your primary fitness goal? Weight/Fat Loss Weight Gain Health & Longevity Muscle Strengthening Do you have any previous injuries or medical conditions (joint issues, surgeries, chronic illness, etc.)? How many hours of sleep do you get per night? What's your sleep quality? Poor Good Excellent What does a typical day look like for you? Wake Time, Meal Times, Bed time What is your stress level on a scale from 1 (low) to 10 (high)? Do you have any known food allergies or intolerances? Yes No What is your training history? Have you followed a program before? Yes No What equipment do you have access to? Gym Home Equipment Both Are there any exercises you cannot perform due to physical limitations? What types of workouts do you enjoy? (lifting weights, walking, yoga, etc.) Do you currently track your food? If so, how? What foods do you enjoy eating? Are there any foods you dislike or refuse to eat? How many meals per day do you usually eat? Do you currently take any supplements? Yes No How many times per week do you eat out? What foods do you crave often? What foods do you always have in your pantry or fridge at home? What are your favorite fast food restaurants or takeout options? How many glasses of water do you drink per day? How do you usually manage stress? What is your current weight and height? What is the biggest struggle or obstacle preventing you from reaching your health or fitness goal? Is there anything stopping you from taking action today? How committed are you to achieving your goals on a scale of 1 (low) to 10 (high)? 1 2 3 4 5 6 7 8 9 10 Explain everything you have already tried to accomplish your goals in the past How old are you? What is your gender? * Male Female Other Prefer not to answer Are you willing to invest, financially, in your health and fitness? I'm not ready to invest in myself My budget is tight but if I'm guaranteed results I'm in I'm ready to invest whatever it takes How did you hear about Jaz Natural Fit? Instagram TikTok Youtube Referral Facebook Other Where are you from and what is your occupation? (Occupation, City, State/Province, Country) What services are you interested in? * Tailored Exercise & Nutrition Plan Tailored Nutrition Plan Tailored Exercise Plan Name First Name Last Name Phone (###) ### #### Email Thank you! Contact Us If you’re interested in collaborating, please provide your information, and we will contact you soon. We look forward to connecting with you.fitjasmine@outlook.com(555) 555-5555 Name * First Name Last Name Email * Message * Thank you!
