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You get out what you put in

It's great to have you join the Smart Kitchen squad. Over the next 10 weeks your Success Coach will  be here to help guide your body into its best shape possible. 

Working with your Success Coach is 100% Optional but we find it really helps to keep you ON TRACK and ACCOUNTABLE. 

To get started we need to know a bit more about you.  You don't have to answer every question but please fill in as many fields as possible and be as honest as you can.  This form should only take 5 - 10 mins max.

We will not share your specific details with anyone outside of our Success Coach team, we just use this information to best understand your current situation, your goals and potential roadblocks so we can best support you.

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* 1. First up we need to grab your First and Last name.  Add your Nickname if you like as well

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* 2. How would you prefer your Success Coach to contact you initially?

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* 3. What is your age range

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* 4. What is your gender?

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* 5. What is your current bodyweight

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* 6. How aggressive would you like your Calorie Deficit to be? (Results may vary and depend on your TDEE calculation)

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* 7. Do you have a long term weight loss goal?  Share this number with us

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* 8. What are the top reasons you would like to lose weight?

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* 9. What are you most looking forward to once you reach your goal weight?

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* 10. What other lifestyle goals do you have?

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* 11. What have been the obstacles, if any, you’ve encountered when trying to attain your goals? (Select all that apply.)

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* 12. Do you work?  If so how many hours per week on average?

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* 13. What do you feel MOTIVATES your food habits and Choices?

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* 14. What other diets have you tried in the past?

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* 15. How successful have your previous diets been? What worked well or didn't work well?

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* 16. Did you weight rebound after you left your diet?

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* 17. Any Allergens or Dietary requirements?

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* 18. Do you have any Physical Ailments or Medical issues?

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* 19. What Physical Activities do you currently do and how often?

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* 20. What benefits do you notice when you are physically active?

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* 21. How often do you drink alcohol and how many drinks in an average session?

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* 22. Have you shared your new health journey with others?  If so what do they think about it?

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* 23. How confident do you feel when it comes to adhering to the program and staying on track?

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* 24. Have you eaten Muscle Fuel before?

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