Coach JM & Team

Thank you for your interest in our health and fitness programs. The #1 reason that people are getting amazing results with us is the individual attention that we give to help them achieve their health and fitness goals. For us to provide you the best possible coaching, follow up support, and personalised program to fit your specific needs, we would ask you to take just 10-15 minutes to complete the Health Evaluation below.

We look forward to receiving your evaluation soon and will be in contact with you in no more that 24-48 hours after receiving your evaluation. Remember: For Things To Change You Have To Change...We are here to help you make those changes together.

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* 1. Your Information

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* 2. How are you directed to this health evaluation?
Eg. from an advertisement OR from a coach (please insert name) OR from a friend (please insert name) etc

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* 3. Physical Details

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* 4. What is your ideal weight that you want to achieve?

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* 5. What are your goals for your fitness/health (you may choose more than one)

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* 6. How long have you been concerned with reaching your goal?

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* 7. List 1-3 things you have tried before or are currently doing to reach or maintain your health/fitness goal. (if nothing leave blank)

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* 8. If what you have tried has not caused you to reach your health/fitness goal, please help us understand why or what the challenges were for you.

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* 9. What is your greatest motivation for wanting to reach this goal? Please take some time with this and be as detailed as possible. This will help you as much as it will help us. (Examples...How you feel about yourself or the way you look...What other people comment or say about you...Special occasions coming up...)

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* 10. How serious are you about reaching your health/fitness goal?

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* 11. How much time do you exercise PER WEEK? (specific exercise times, not including normal daily activities)

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* 12. Sleep Times

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* 13. Quality of Sleep

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* 14. Breakfast Information

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* 15. Lunch Information

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* 16. Dinner Information

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* 17. What do you normally like to eat as a snack?

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* 18. What time of day do you like to snack? (you may choose more than one)

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* 19. Check anything that applies to you

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* 20. How much plain water do you drink per day?

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* 21. Mark all health conditions that apply to you

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* 22. Do you have friends that need help with their health and/or fitness?

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* 23. Would you be interested to know about our referral benefits program

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