Your Diet Coach - Online Questions I need to know about you.

Online Questionaire

Client Questionaire

You will be required to send three digital photos of yourself (front, side and back) for assessment. Additional photos will be required as your program progresses. Email your photos to nathan@yourdietcoach.com.au once you have signed up for a program

Personal Information

Name
Age
Date of birth
Address
Email
Phone number
Occupation
No. of children

General Information

How many hours per day do you work?
What time do you get up?
What time do you go to sleep?

A typical days eating would be (with approx times)?

What supplements and / or medications are you currently using?

Do you have any food allergies? What foods don't you like?

Do you currently go to the gym? If yes, what is your weekly training schedule?

Do you currently do any cardio? If yes what is your weekly schedule?

What is your current body weight in the morning?

Have you had a nutrition or training program before? What did you like / dislike about it?

What are your goals for your body?

How did you hear about us?

Internet
Flyers
Print ad
Referral
Other

Are you interested in:

General Wellness
Womens Figure Shaping
Mens Toning
Bodybuilding or Figure Competition

What is your past medical history?

I AGREE TO ALLOW NATHAN BRAYSHAW AND YOURDIETCOACH.COM.AU TO DESIGN A WEIGHT MANAGEMENT PROGRAM FOR ME TO ENHANCE MY HEALTH & FITNESS GOALS. I WILL FOLLOW THAT PROGRAM TO THE BEST OF MY ABILITY AND I WILL NOT HOLD NATHAN BRAYSHAW OR YOURDIETCOACH.COM.AU OR ANY RELATED PERSONS OR PARTIES PERSONALLY LIABLE FOR ANY PROBLEMS, ILLNESSES OR INJURIES THAT MIGHT OCCUR DUE TO A SUDDEN CHANGE IN MY EATING HABITS. THIS WEIGHT MANAGEMENT PROGRAM DOES NOT REPLACE THE EXPERT ADVICE OR MEDICAL TREATMENT OF MY OWN PRIVATE DOCTOR. I HAVE GIVEN NATHAN BRAYSHAW AND YOURDIETCOACH ALL NECESSARY INFORMATION ABOUT MYSELF TO PREVENT ANY POSSIBLE COMPLICATIONS

I Agree