Your Full Name*

Your Email*

Your Age?*

Your Weight?*

Your Height?*

What does your current exercise routine consist of? Include any sports, classes or activities*

Do you have an active job or a desk job? If active, please provide some details*

Do you consume alcohol? If so, what type of alcohol and how often?*

Do you smoke? If so, how many cigarettes per day/week?*

Do you feel you suffer from stress? If so, how does it affect you?*

How many hours of sleep do you average per night? Do you sleep well or is it broken sleep? How do you feel first thing in the morning?*

What do you eat on a typical day? Include snacks and soft drinks*

How many nights per week do you order a takeaway or eat out?*

Are you allergic to any foods? Which foods do you dislike? Which foods can you not live without?*

Please tell me your top 3 goals for this program?*

What would success look like for you after 12 weeks?*

What are the main obstacles that are preventing you from achieving your goals?*