Email *
What was the number one reason you signed up for Self Made? *
What has been the biggest obstacle in the past to you achieving your goals? *
What are your top 3 goals for these first 6 months? (be as specific as possible) *
Why do you want to achieve these goals? *
Why do they feel important to you now? *
What obstacles have you had in the past when it comes to achieving these goals? *
How will you feel when you achieve these goals? *
Can you feel that way now, before you achieve your goals? (please explain why or why not) *
What do you believe about weight loss? *
What would you LIKE to believe about weight loss? *
What do you believe about your ability to lose weight and keep it off? *
What works best for you when it comes to accountability? *
How will you hold yourself accountable? *
Besides using a scale, how will you measure your progress? *
If you did not ever use the scale, how will you know if you are achieving your goals? *
What excites you most about getting started? *
What is your current weight (or approximate)? *
What is your goal weight for the next 6 months? *
What is your long-term goal weight? *
When was the last time you were at this weight? *
Why is this your goal? *
Height *
Age *
How much cardio do you do weekly? *
Are you getting started or “re-started” with strength training? *
How much strength training do you currently perform weekly? *
Where do you perform the majority of your strength training? *
If other, please specify.
Supplements, prescriptions and health background: Do you have any medical conditions, limitations, or prescription medications that we should be aware of?
What supplements do you take regularly? If you know the brand please include that as well. *
Do you have a physician who does hormone testing for you? *
Are you taking any hormones currently? *
Do you have questions about hormones or suspect a hormone imbalance? *
Do you have any food sensitivities or allergies? Or any suspected ones? What are they? *
What time do you go to bed? *
What time do you usually fall asleep? *
What time do you wake up in the morning? *
Do you take any prescriptions or supplements for sleep? Please list *
Do you drink coffee or caffeinated beverages? *
How much coffee (or caffeinated beverages do you drink daily) in 12 oz increments? *
What is the latest in the day that you will drink caffeine? *
Do you drink alcohol? How many drinks per week do you typically have? *
What obstacles might you have when it comes to eating what you have planned for the day? *
Have you ever been diagnosed with an eating disorder? If yes, please give background or details. *
Do you use food when you’re stressed or experiencing uncomfortable feelings? If no skip next question. *
What feelings or stressors typically make you reach for food? *
Since you chose option 2, Meal Plan, do you have a preference for number of meals daily? Are you PLANT BASED?
What do you think has been your biggest challenge for you when it comes to losing weight? *
What do you think has been the biggest challenge for you when it comes to maintaining a weight loss? *
Are you willing to work on yourself even when it’s hard? *
What is the ideal outcome for you in our time together? *
Is there anything else we should know? What didn’t we ask you that you think might be helpful for our coaching relationship?