Initial Assessment Questionnaire

The initial assessment questionnaire is designed to help us better understand your unique needs, goals, and circumstances. This questionnaire is your first step towards a personalized and effective coaching experience.

The information you provide will enable us to create a tailored coaching plan that aligns with your aspirations, health status, and readiness for change. Your participation in this assessment is a crucial part of our collaborative journey towards a healthier, happier you.

The information submitted through the Initial Client Assessment Questionnaire is treated with the utmost confidentiality and respect. For more information regarding how the data is collected, stored and used, please see the Privacy Policy.

Thank you for taking the time to complete this questionnaire. Your input is invaluable, and I look forward to helping you on your journey toward improved health and nutrition.

Contact Information

Tell me more about yourself.

By learning more about your lifestyle and your habits, I can take better care of you and make sure coaching is a good fit for your goals and individual needs.

In general, what are your goals? Check all that apply.

What are you doing right now?

These questions help me learn more about your general history of health, eating and exercise, as well as how knowledgeable and/or competent you are in these areas.

Provide your rating on a scale from 1 to 10, with 1 being 'Horrible', and 10 being 'Awesome'.

Tell me about your environment.

Helping me understand more about your environment is crucial for gaining insight into various aspects of your life. This knowledge will help me provide more effective guidance, recommendations and support that take into account the specific nuances of your family dynamics and daily life.




Check all that apply.
Check all that apply.
Check all that apply.
Check all that apply.
Provide your rating on a scale from 1 to 10, with 1 being 'Not at all', and 10 being 'Completely'.

Let's discuss your health.

The responses in this section provide me with a baseline understanding of your overall health status. This knowledge is essential for tailoring plans that are appropriate and safe for your specific health needs.

Provide your rating on a scale from 1 to 10, with 1 being 'Worst', and 10 being 'Awesome'.
Provide your rating on a scale from 1 to 10, with 1 being 'My life is packed and insane', and 10 being 'My life is completely calm and relaxed'.

Your stress and recovery

This assessment will help me tailor your coaching plan to effectively manage stress and optimize your overall well-being. Your input here will be invaluable in creating a plan that fits your unique lifestyle and needs.

Think about all the activities you’re involved in (e.g., work, school, caregiving, housework, travel). Then assess as best you can on a scale from 1 (No stress) to 10 ( Extreme stress).

How ready, willing, and able are you to change?

In this section, we will explore your readiness and motivation to make positive changes in your life. I want to understand your level of commitment, your enthusiasm for change, and the resources you have available to support these changes. Your honest input will guide mw in creating a coaching plan that aligns with your readiness, helping you take meaningful steps toward your health and wellness goals.

Provide your rating on a scale from 1 to 10, with 1 being 'Not at all', and 10 being 'Completely'.
Provide your rating on a scale from 1 to 10, with 1 being 'Not at all', and 10 being 'Completely'.
Provide your rating on a scale from 1 to 10, with 1 being 'Not at all', and 10 being 'Completely'.

What do you expect?

This is an opportunity for you to share your expectations and goals for our coaching relationship. I want to understand what you hope to achieve, what outcomes you're aiming for, and any specific expectations you have regarding the coaching process. Your input here will help us tailor our approach to meet your needs and ensure that our coaching sessions are aligned with your desired outcomes. This section is all about setting clear expectations and working together to achieve the results you're looking for in your health and wellness journey.

Disclaimer

Disclaimer
Please recognize that it is your responsibility to work directly with your health care provider before, during, and after seeking
nutrition and / or fitness consultation.
Any information provided is not to be followed without prior approval of your doctor. If you choose to use this information without
such approval, you agree to accept full responsibility for your decision.