Skip to content
Toggle Navigation
Book Here
Contact
Contact
Facebook
Instagram
Twitter
Email me
Newsletter
My recipes
Blog
Blog
Restricted content
Gallery
Extras
Health Questionnaires
Health Questionnaire – Private Clients Only!
Testimonials
Event Feedback Forms
The Body Fuel Mastery Coaching Programme
The Body Fuel Mastery Coaching Programme – Progress Check In
Brusnmeer Football Team – For Parents Only!
Brunsmeer Football Team – For Team Players Only!
For Guides and Scouts
SSCH Wellbeing Questionnaire
Allergens
FAQ
Team Building & Wellbeing
Culinary Medicine & Nutrition Coaching
Peri-menopause & Menopause coaching
The Body Fuel Mastery Coaching Programme
Please enable JavaScript in your browser to complete this form.
Full name
*
Phone number and email address
*
Please provide your date of birth, your height and weight.
*
Where did you hear about this coaching programme?
*
How would you rate your health right now on a scale of 1-10? And why that score?
*
What is the main reason you want to improve your health? What is your ultimate health goal?
*
What does a typical day in your life looks like? What routines do you follow, if any? (If on shift work, what does that look like?) What is your profession? How many hours do you work a day. Do you spend most of your day at your desk?
*
Are you on any medications? Do you take any supplements? Please provide details (what, brand, dosage per day and who recommended taking these).
*
What causes the biggest discomfort in your current lifestyle? What helps you cope with this?
*
Have you got any allergies or food intolerance? Please provide details.
*
What are your favourite meals? (List minimum 5-6!)
*
Any dish or food item you dislike or cannot tolerate?
*
Do you drink alcohol? What, how often and how much? (Weekly / daily)
*
What other beverages do you drink? How often and how much? Coffee, coke, tea, coke – anything that contains caffeine please list. How much water do you drink?
*
How many hours do you sleep at night? Do you wake up at night? Do you suffer with insomnia?
*
How often do you cook for yourself a week? Do you enjoy cooking? Is there anything you would like to learn specifically?
*
How do you shop for food? How often? Online or in store? Do you meal plan and write a list?
*
How would you rate your daily stress level? Any recent trauma / stressful situation that you think affects your current lifestyle?
*
Tell us about your training experience to date. What activities have you done and enjoyed? What exercise regimes you didn't enjoy in the past and why?
*
What training equipment do you have at home? Please list all.
*
Have you had any operations or injuries recently? Do you have any pains or niggles? How does it affect your every day activities?
*
How many times a week can you see yourself training and what times work for you best?
*
Are there any body-parts or specific exercises you want to focus on?
*
Do you keep a training log?
*
Yes
No
How many steps do you do daily on average?
*
What do you think needs to be improved with your training?
*
What would need to happen for you to label this coaching journey as a success? Where would you like to be in 30 days / 90 days or 6 months?
*
Imagine that you are living your healthiest life. How do you feel in your body and in your mind? What is different to now? What could prevent you from achieving this?
*
Is there anything else we should know about?
*
Submit
82612