WEEKLY ACCOUNTABILITY COACHING Questionnaire General Information Name * First Name Last Name Email * Weight (lbs) * Age * Sex * Male Female Height * What is your main fitness goal? * Provide as much detail as possible. How many pounds? By when? Movement On average, how many steps do you take per day? * 0 -2,999 3,000-5,999 6,000-8,999 9,000+ What is your level of exercise activity? * 0 (completely sedentary) 1 2 (walking, gardening, light hobby) 3 4 (light weightlifting or cardio 1-3x per week) 5 6 (weightlifting or moderate cardio 4-5x per week) 7 8 (training for marathon) 9 10 (training for ultramarathon) Sleep On average, how many hours of sleep do you get per night? * 6 hours or less 7 hours 8 hours 9 hours or more Do you wake up feeling tired? * Most of the time Sometimes Rarely Nutrition What does a typical day of eating look like? * Include the time of day and food. What option best applies to you? * I eat mostly unhealthy food. I eat mostly nutritious foods - lean proteins, vegetables, fruits, whole grains. I eat nutritious meals with well balanced protein, carbs and fats. I track my calories/macros. I track my calories/macros and schedule my meals throughout the day. What is one thing you would like to change about your nutrition? * Would you like to try tracking your calories for this diet phase? * Yes No Other Is there anything else we should know about your medical history? Thank you! We will reach out to you shortly.