Wellness4Moms Online Health Coaching HEALTH ASSESSMENT Fill this out to book a FREE 20 min Health Consultation Name(required) Email(required) Phone Number(required) What is your current fitness level?(required) Beginner Intermediate Advanced Tell me what you want to accomplish health-wise and why. (Be specific - improve mental clarity, keep up with kids, weight loss, build confidence, etc)(required) How long have you wanted to make this change? (required) What have you tried in the past? (required) Why did it fail, or not last longterm, for you? (N/A if this doesn't apply)(required) Tell me about your support system. (Who lives with you? Are you on your own? Who knows you are trying to make health changes? Are they supportive? Will they help or do it with you?)(required) How often do you go out to eat?(required) Never A Few Times a Month 1-2 x per week 3-5 x per week Almost Daily Daily Tell me about your energy levels. Do you feel like you are full of energy or do you get tired a lot?(required) Do you feel like you are at a plateau with your weight loss?(required) Explain to me what you eat and drink on an average day. (required) Do you think you'd benefit from more structure in your nutrition program or more flexibility?(required) Structure Flexibility What does a typical day look like for you? (Do you have any quiet moments during the day? Do you have downtime? Do you watch a lot of TV? Are you hustling from thing to thing?)(required) What workout equipment do you have at home?(required) How much time do you have to workout per day?(required) 20 min 30 min 40 min 60 min Would you like to be considered to participate in my next Online Accountability Group where we focus on overall Health and Mindset by following a specific workout plan (tailored to your goals), improving our mindset and self-confidence, eating primarily Whole Foods, and following a simple nutrition plan? Yes Maybe No Send Me More Information Submit Δ BOOK NOW Share this:FacebookPinterestTwitterLinkedInWhatsAppEmailLike this:Like Loading...
Fit Mom Ashley 