EMAIL ASSESSMENTMETABOLIC ASSESSMENT QUESTIONNAIRE STEP 1: Take a few minutes to fill out this questionnaire so I have all the information necessary for our call.STEP 2: After submitting, set a day and time for our call that works best in your schedule.On the call we will discuss exactly what is holding you back and create your individual plan so you can start seeing success. Name * First Name Last Name Email * Phone * (###) ### #### Country * USA Canada Ireland UK Other What timezone are you located in? * What is your #1 goal right now? * What is your biggest struggle when it comes to reaching that goal? * What is your current occupation and typical day like as far as movement? * Briefly describe your typical day as far as breakfast, lunch, dinner & snacks * Age * Height * Current Bodyweight How many times per week on average do you strength train? * 0 1 2 3 4 5 6 7 How many times per week on average do you do cardio? * 0 1 2 3 4 5 6 7 Do you currently take any medications that can affect your ability to lose weight? (antidepressants, anti seizure meds, diabetes meds, contraceptives, endometriosis treatment, alpha/beta blockers, antivirals, steroids, antihistamines/anticholinergics, Yes No Would rather not say Do you count calories? If so, what is your daily average? * Are you interested in FIT40 Nutrition Coaching? * Yes - I would like to hear more about it Yes - in the near future, but not at this time No
