Weight Loss Consultation Form | Form For Weight Loss

1. What are your age, height, and body weight?

2. What do you want to achieve if you were to work with me?

3. What is your ideal body weight?

4. What are the three biggest barriers to achieving your ideal weight?

5. Was there any time in the past when you were very happy with your weight?

6. Do you engage in any physical activities on a regular basis?

7. Are you currently working? If so, does your job require you to sit for long periods?

8. Do you prepare most of your meals at home?

9. How often do you eat out?

10. If we decide that we are a good fit to work together, are you willing to make gradual changes to achieve your weight goals?

11. Are you able to commit to paying a few hundred dollars a month for the coaching?

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