Quastionnaire-Workouts - Weight Loss Specialist in women

Name *

First

Last

Email *

Phone number (with country code)

Date of birth *

Where do you live? (country, city) *

What is your occupation? *

Height (in cm) *

Weight (in kg) *

Waist and hips circumferences in cm

What is your goal? *

You can also write Short, Medium and Long-term goals (e.g. I wish to achieve… in 1, 6, 12 months)

Your issue story

If excess weight, when appeared, did you try any diets, workout programmes or other weight loss methods, etc.

Do you have any chronic diseases, which ones if yes? *

Did you have any operations, injuries, serious acute conditions, which ones if yes? *

Aren`t you in a special condition such as pregnancy or breastfeeding ? *

Did you give a birth, and how many times if yes?

Do you take any medicines constantly? If yes please write the name and dose *

Do you smoke (constantly)? *

How much water approximately do you drink a day? *

How many times a day do you eat? *

Write down here everything you ate yesterday or other usual day (time, what exactly, the amount)

Describe your usual day plan (waking up time, work, exercising, going to bed time etc.)

Do you do any sports? If yes – since when, what exacltly and how many times a week? *

How long in minuts do you exercise, which level you think you are (e.g. beginner/intermediate/advanced)? *

What are your preferances in exercising?

E.g. “I like mat/floor/standing/chair workouts, or I like workouts with dumbbells/resistant bands, etc.”

Do you have any fitness equipment at home? *

Please here mention anything you would like to use in your Programme

What type of workouts you find too hard, or not good for you due to some health issues? *

For example, “I can`t bear high intensity/resistant/weights workouts, etc.”

What type of exercises you don`t want to be included in your Programme?

For example, squats/lunges/planks. Please, write anything you don`t like

Would you like to have music on the background of your videos or you prefer to turn your own tunes?

How you would like me to send your videos? *

Which source did you hear about me from? *

If there are any blood tests or other examinations you have, please send them via WhatsApp/email

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