Coaching Questionnaire

General

Name(required)

Email(required)

Age

Weight

Describe your main problem to me and make a list of all the symptoms you have.

Do you smoke weed? If so, how frequently?

Do you drink alcohol? If so, how frequently?

Do you smoke cigarettes?

Do you drink coffee? If so, how many cups per day?

Do you use any pharma drugs? For hypertension, diabetes, hair loss, etc.

Lifestyle

Do you exercise? If so, what kind of exercise, how much and how often?

What part of the day do you have the most energy?

Do you get a dip in energy during the day?

Do you do intermittent fasting or some sort of eating frequency modification?

Stress

Is your job stressful?

Is your family dynamic stressful?

What are the top 3 things you stress about the most?

Sleep

How is your sleep quality? (e.g. do you wake up during the night, do you sleep restless, etc.)

Do you snore?

Do you have sleep apnea? If so, are you doing anything about it? (CPAP, etc.)

When do you generally go to bed and get out of bed?

How many hours before bed do you have your last big meal?

Do you snack before bed? If so, what do you snack on?

Gut health

Do you have a white tongue?

Do you have indigestion and GERD (acid reflux)?

Do you bloat during the day?

How many bowel movements do you have per day?

What is the quality of your stool? (E.g. perfect, slow, loose, hard, tarry, pebbles, etc.)

Diet

Do you have specific food sensitivities? (Dairy, eggs, gluten, etc.)

What does your diet look like at the moment? Break it down into "breakfast" "lunch" "dinner" and "snacks".

Do you prefer white or red meat?

Do you prefer fatty or lean meat (ribeye vs top sirloin, chicken thigh vs chicken breast)?

Supplements

What supplements are you currently using?

What have you tried before that didn't work?

What have you tried before that did have a beneficial effect?

Coaching Questionnaire

General

Lifestyle

Stress

Sleep

Gut health

Diet

Supplements

Like this:

Related Posts:

General

Lifestyle

Stress

Sleep

Gut health

Diet

Supplements

Share this:

Like this:

Related Posts: