Success Stories
5 Day Free Plan
Free Calorie Calculator
Coaching
About me
Blog
Calculations questionnaire
Calculations
Name
*
First
Last
Date
*
DD slash MM slash YYYY
Email
*
Phone (Optional)
This is optional, and just in case we need to contact you regarding your targets. We will not send any marketing or share your details.
Sex
*
Female
Male
Age range
*
10 - 17 years old
18 - 29 years old
30 - 59 years old
60 - 74 years old
Please select the relevant age range from the drop down above.
Height (cm)
*
Please enter your height in Centimetres
Current Weight (Kg)
*
Please enter your weight in Kg.
What are your current nutritional goals?
*
to gain weight
to decrease weight
to decrease body measurements
to achieve a healthy diet
to improve sports performance and recovery
other
Please tick next as many as are appropriate. If other, please specify below.
Other (please specify)
What is your occupation?
*
Occupational Activity
*
Light
Moderate
Heavy
How active are you at work? Light would be sedentary desk job. Moderate might be teaching, hairdressing, on your feet all day. Heavy is building, warehouse type work, heavy lifting etc.
Non Occupational Activity
*
Light
Moderate
Heavy
How active are you outside of work. Light is up to 3 days a week light exercise. Moderate is 2-5 moderate/hard exercise a week. Heavy is 6-7 days a week hard exercise.
What reasons do you have for wanting to achieve these goals?
*
When do you want to achieve these goals by?
*
We will cover goals in more detail soon so just a rough timescale will do for now.
How motivated are you to achieve these goals?
*
1
2
3
4
5
6
7
8
9
10
Choose from the drop down - 1 is not at all, 10 is extremely motivated.
Have you tried to achieve these goals in the past?
*
Yes
No
If yes, what success did you have?
What problems did you encounter?
Can you think of any situation/people that may prevent you from achieving these goals?
Indicate above what/who they are.
Do family, friends and/or colleagues support you in this?
*
Yes
No
Name
This field is for validation purposes and should be left unchanged.
Want to learn more?
Check out these articles below
“It’s an instant failure when you look in the mirror…”
Read More
Meet Anne, and hear her success story!
Read More
Is your environment causing you to FAIL?
Read More
How do I lose a few pounds?
Read More
Processing...
