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Free Lifestyle Check – Personalised Fitness & Nutrition Assessment
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Personal Details
Full Name
*
Email
*
Instagram Handle (optional)
Goals
What are your primary fitness goals?
*
Lose Weight
Build Muscle
Improve Endurance
Increase Strength
Other
Please specify
What is your biggest challenge when it comes to fitness or health?
Current Fitness Routine
Do you currently exercise?
*
Yes, regularly (3+ times a week)
Sometimes (1-2 times a week)
Rarely/Never
If yes, what type of exercise do you usually do?
Cardio (running, cycling, etc.)
Weight Training
HIIT
Yoga/Pilates
Other
Please specify
Nutrition & Diet
How would you describe your current diet?
Very Healthy
Somewhat Healthy
Needs Improvement
Unhealthy
Do you follow any specific dietary guidelines or restrictions?
Vegetarian
Vegan
Low-Carb
High-Protein
None
Other
Please specify
Daily Habits
On average, how many hours of sleep do you get per night?
Less than 5 hours
5-6 hours
7-8 hours
9+ hours
How would you rate your stress levels?
High
Moderate
Low
Availability
How much time can you dedicate to fitness each week?
*
Preferences
What type of coaching or plan do you feel you need most?
Workout Plan
Nutrition Plan
Accountability & Support
All of the above
of any If
Anything else you’d like me to know?
Submit
