Mind Body Connection Quiz

High Note Performance Metabolism Quiz

First Name *

Last Name *

Date of birth *

Email *

Phone

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Do You Currently Have a Fitness Goal?

Fat loss, muscle gain, movement quality, strength/speed/endurance improvement, ect.

Current Fitness, Nutrition, and Activity Level

If you're currently following a plan, tell me the outline (weight training 3/week, eating 1900/calories) *

Include any activity you do in your free time. Dance classes that are part of your school curriculum don't count.

How Important is it to improve your singing and athleticism?

Scale of 1-10. Select the most correct answer *

How did you decide on that number?

When you know why you want something, you're much more likely to achieve it.

Athleticism and Medical History

Medical and Injury History

Please list any medical history, conditions, or medications that we should know about: *

Please include any diagnosis, motor vehicle accidents, cancers, head trauma, surgeries (medically needed and elective), as well as any scars or previously broken bones.

What are the major obstacles you've encountered in your athleticism journey so far?

Lack of knowledge, motivation, accountability? Pain? Self-sabotage?

Nutrition Information

True Athletes treat themselves properly all the time.

Height

Please include the unit (Feet, Inches, CM) *

Current Bodyweight

Please include the unit (Pounds, KG, Stone) *

How Many Times a Day Do You Eat?

Meals + Snacks *

How Would You Rate Your Current Food Quality?

Scale of 1-10, select the most correct answer *

How Many Calories Do You Eat Each Day?

If you're unsure about calories or have not been consistent, that's okay! Just let me know below. *

How Would You Rate Your Relationship with Food?

Scale of 1-10, select the most correct answer. *

Please Include Anything Important About Your Nutritional History Below

Include previous diets you've used, any food allergies or intolerances, and any history disorder eating, or diagnosed eating disorder. *

A simple 1-10 scale leaves a lot of space for grey unexplored. Please go into as much detail as you feel is valuable.

Stress Management

You're almost done! Last few questions --

How Would You Rate Your Average Stress Level?

Scale of 1-10, select the most correct answer *

How Do You Currently Cope With Stress?

"I don't" is an acceptable answer here - but more detail would be helpful. *

In The Last Six Months How Much Sleep Do You Get?

Average everything out *

How Would You Rate Your Average Sleep Quality?

Scale of 1-10, pick the most correct answer *

Did We Miss Anything?

If there is anything else you think would be important for me to know, please include it below. *

Have you ever considered hiring me as your 1:1 coach?

Yes

Please Complete the Quiz Below