Your Name (required)
Would you like to be added to the CO2Fit Email List?
What are your specific health & wellness goals? (lose # of weight, start exercising, etc?
What do you think you will gain from achieving these goals? How would it impact your life?
What other programs/products have you tried in past? Why did these programs work or not work?
At what point in your life did you feel best?
Any serious illnesses/hospitalizations/injuries?
Do you eat three meals a day? If no, which meal do you skip?
What foods did you eat often as a child?
What is your current daily meals and snacks look like? (more info you can give here, better your nutrition plan will be. if you keep food journal, please share pages from it)
How often do you eat out? Where?
Do you have problem with snacking/grazing all day? If yes, what time of the day or evening is hardest to control?
What is your favorite snack?
Do you take any supplements or medications? Please List.
How many glasses of water do you drink daily?
How is your digestive system? Indigestion or irregularity?
What is your energy level? (1 very low to 10 very high)?
How much caffeine do you take daily? What kind (coffee, tea, energy drinks, soda)?
Do you crave sugar, coffee, cigarettes, or have any major addictions?
The most important thing I should change about my diet to improve my health is:
What does your current exercise plan look like? What activities, how often, and for how long?
Which activities do you enjoy doing? (i.e. hiking, dancing).
Which activities do you hate doing? (i.e. running)
Which activity did you always want to try and have not tried yet?
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