Questionnaire
Name:Age:
Height:Current weight:
Diet & Lifestyle Habits
1. Explain in detail what a typical day looks like with food, what do you eat for each meal?
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2.What food would you say is your ultimate downfall?
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3.Do you drink alcohol, if so how many units per day or week and what is your drink of choice? Answer
4.How would you describe your lifestyle - socializing etc..
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5.What time of day do you eat the most?
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6.Will your family/friends be supportive during this programme?
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7.How active are you?
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8.Is there anything you do not eat?
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9.What vegetables do you love most?
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10.How many cups of coffee do you drink a day andhow do you drink it (i.e. sugar, low fat milk)?
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11.What fluids do you currently drink?
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12.Are you on any medication or have any illness?
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13.Vitamins /supplements you are currently on?
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14.What is your favourite protein choice- chicken, fish or steak? Do you eat ostrich?
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15.Do you like hake and tuna? Do you like cottage cheese?
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16.How much salt do you eat, teaspoons per day?
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19.What carbohydrates do you like most: Baby potatoes, sweet potatoes, brown rice, couscous, rye bread? Answer
20.Do you LIKE and eat eggs?
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21.Explain previous diet history in detail please, what diets have you tried, diet pills etc.
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22.Any special requests, i.e. Do you travel often, eat out a lot? Where do you eat at?
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23.What is your ideal weight?
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24.Do you eat avo, olive oil, olives, coconut oil, raw unsalted nuts?
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Training Habits
1.What is your current training routine?
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2.What exercises do you battle with the most?
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3. What time of the day do you workout?
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5.How long do you currently workout for?
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6.What type of body do you aspire to have, what are your exact goals and what do you expect from a gym programme?
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7. Do you want a home or a gym programme or are you happy with just a diet plan?
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8. How many days a week and for how long?
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9.If you want a home training programme, what equipment do you have access to (if any)?
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“Believe in yourself and all that you are. Know that there is something inside you that is greater than any obstacle.”
Questions compiled by Kelly Stegen. © Kelfit Lifestyle