Healthy Self Mentorship Program Questionnaire

HealTHY Self

Mentorship program
questionnaire

Healthy Self Mentorship Application Form

Ready to join Chady Fit and take your goals to the next level? I am more than happy to guide you to becoming the best version of YOU!
Please take the time to fill out the questionnaire below and I will email you back within 48 hours!

Full Name*
Date of Birth*
MM slash DD slash YYYY
Age*
Height (ft)*
Weight (lbs)*
Location*
Street Address City State
Phone Number*
Email*
Occupation*
Excercise/Goals Related Questions:
1. What would you like to achieve by working with Chady Dunmore as your Trainer/Lifestyle Coach?*
2. What are you willing to do to make this a reality?*
3. How will you feel when these goals are accomplished?*
4. How much time are you prepared to dedicate to this?*
5. Have you had any previous injuries/medical complaints that could impact upon an exercise or nutrition regime?*
6. Have you previously worked with a coach or online trainer in the past?*
7. What is your general health like?*
8. Do you take any supplements? If so, which ones and how often?*
9. Previous exercise history - please be as detailed as possible:*
10. What type of exercises do you enjoy*
11. What type of exercises do you dislike?*
12. How often are you able to exercise?______ x/week*
13. What are the best days during the week for you to commit to your training program?*
14. What is your Ultimate Goal? For example: In 12 weeks, 6 months, 1 yea, What would you like to have achieved?*
15. Do you have a date chosen for a competition?*
16. If so, are you looking for a 12, 16, or more time to prep*
17. Are there any areas you specifically would like to improve and focus on? For example: specific targets, lowering body fat, increasing lean muscle, rehabilitating past injuries, spot specific training, wedding, NPC competitions, eliminating joint pain (knees/back/hip) etc.*
Nutrition Related Questions:
1. On a scale of 1-10, how would you rate your Nutrition (1=very poor 10= excellent)?*
2. How much water do you drink each day?_____Liters_____*
3. How many times/day do you eat?*
4. How many times do you prefer to eat based on your schedule? 4-7 (note: your calories/ macros will be the same for you but meals may be more spread out if that is your preference)*
5. Do you eat breakfast every day? YES/ NO*
6. Do you drink coffee? If so how many cups/day and what time? _____Cups, Time*
7. What do you mainly crave? Is there anything that you absolutely must have on your nutrition program?*
8. Are you allergic to any foods or do you dislike any foods that you can't include in your meal plan?*
The following is a record of your daily food intake at the moment. Please give an accurate description of what foods and drinks you consumed during your last regular working day. Make sure you record the time of each meal. Please be detailed and honest as possible (no judgments :))
Typical Breakfast & Mid-Morning:
Typical Lunch & Mid Afternoon:
Typical Dinner / Late Night Snacks:
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HealTHY Self

Mentorship program
questionnaire

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HealTHY Self

Mentorship program questionnaire

Join My Newsletter

Step your health/fitness game up, join FREE along with thousands of others.

Mentorship program
questionnaire