Wellness Coaching Questionnaire Name * Email * Address Phone (###) ### #### Occupation and/or hobbies Are there certain days/times of the day that are typically best for our weekly 30 minute phone meetings? What goals would you like to achieve with wellness coaching? Gender Female Male Age Height How much weight do you want to gain/lose? Current Weight Goal Weight What programs/methods have you tried to gain/lose in the past? What are some of the obstacles to meeting your goals that you have faced in the past? Do you typically eat three meals a day, and if not, which meals do you skip? Do you snack between meals, and if yes, when do you tend to snack? If you snack, what do you snack on? How many times per week do you eat out or order in (including all meals)? Rate your energy level on a scale from 1 to 10 Approximately how many ounces of water do you drink in a day? Do you drink other beverages and which ones (juice, soda, alcohol, coffee, tea, energy drinks)? Do you have any food allergies, aversions, sensitivities or restrictions? If so, please list them Who cooks for your household? Who grocery shops for your household? Do you currently exercise? If so, how many days per week and for how long? If you exercise, in which types of exercise do you typically engage? Do you have access to workout equipment or subscriptions to any class/program services (i.e. Beach Body, Peloton digital, etc), and if yes, what is available? Do you have any aches or pains that inhibit your ability to do certain exercises? If so, please list them Are you currently pregnant or breastfeeding? How many hours of sleep do you average per night? Do you have any health concerns that you'd like to share with me, as they may impact your plan and strategies for achieving your goals (i.e. diabetes, cardiac conditions, thyroid disorders, depression/anxiety, arthritis, asthma, etc)? Please explain and challenges How did you hear about Armour Wellness Collective? Thank you!