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COACH NAOMI
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PORTFOLIO
COACH NAOMI
WEIGHT LOSS AND BODY TRANSFORMATION COACHING FOR WOMEN. TRAINING AND MEAL PLANS FOR AMAZING PHYSIQUE TRANSFORMATIONS
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Questionnaire
Name
*
First Name
Last Name
Email
*
Mobile Number
*
Country
(###)
###
####
Date of Birth
*
MM
DD
YYYY
Current Weight in Kilos
*
Height
*
What are you Body Transformation Goals?
*
How would you describe your training experience?
*
Experienced with structured training
Have trained on and off over the years
New to structured training
How would you describe your level in the gym?
*
Experienced
Competent
Novice
What is your training location preference?
*
Gym
Home Based
If training at home, what equipment do you have?
Do you want sport specific programs for any of the following included?
*
Paddling OC1
Running
Cycling
Swimming
Triathlon
None
What does your current exercise regime consist of?
*
Is there any reason why you're not able to do certain exercises/movements?
*
Do you have any injuries or recent surgeries I should be aware of?
*
Do you train with a Garmin or Smart Watch
*
Yes
No
If yes, what is your Garmin account name/link (so I can connect with you)
Would you consider investing in a Garmin for achieving optimal performance and performance monitoring and tracking?
Yes
No
Maybe
Would you like information on getting a DEXA body scan done to measure your starting body fat?
Yes
No
Your current VO2 Max if you know it
Dietary Preference
*
No Preference
Omnivore
Pescatarian
Vegetarian
Vegan
Ketogenic
Carnivore
Dairy Free
Gluten Free
Religious Specific
Other (expand below)
What are your current eating habits? What is an example of a typical day of eating for you?
*
Do you have any issues in the following areas?
*
Pregnant/Trying
Menstruation/Menopause
Digestion/Gastric
Headaches/Migraines
Food Intolerances
Insomnia
Depression/Anxiety
Constipation/Diahorrea
Other
None
Expand on any health conditions or illnesses
*
List any current medications
*
What day of your cycle are you on? (if applicable)
What is the average length of your cycle? (if applicable)
How much water do you drink a day?
*
How much coffee do you drink?
Do you smoke?
*
YES
NO
Do you drink alcohol regularly?
*
YES
NO
What time do you usually wake in the morning?
*
What time do you usually sleep at night?
*
What is your usual schedule on a weekday?
*
What is your usual schedule on the weekend?
*
What areas do you struggle with the most?
*
Motivation
Sticking to an eating plan
Food temptations
Lack of support
Mindset
Understanding exercises
Health condition
Lack of knowledge
No relevant struggles
Your TOP 3 goals
*
What are the 3 most important goals you want to get out of the next 12 weeks?
Any additional information you like to share with me
