Remote Program Start Up Questions – Youth & Vitality Weight Loss

Name *

First

Last

Age *

How many phone consultations per week would work best for you: 1, 2, or 3? (15 min duration) *

2. Would you like to make any in person visits? (A complimentary 1 full Body Composition Scan with review is included with the coaching.) *

What ways do you feel best supported? *

What time do you typically have breakfast? *

What is your main source of protein currently? *

How much water are you drinking? *

What time of day do you feel the hungriest? *

Do you eat in the late evening? If yes: What do you eat usually? *

What is a normal lunch / dinner? Please give at least 2 examples from your most recent meals. *

What foods do we need to avoid altogether if any? (Veggies, Protein, etc.) *

Out of the following: Chicken, Ground Beef, Fish, What do you want to eat the most? *

Do you have a protein you would prefer to avoid or use more often? *

Do you plan on having any alcohol within the first 2 weeks of your program? *

Are you doing any traveling in the near future? If yes - when & where are you going? *

Do you have strong sugar cravings after meals? In general? *

On a scale from 1-10 how intense are your carb cravings? 10 being the most intense. *

Do you like apples? *

What foods are you most hoping I incorporate? *

What are your favorite vegetables? *

What salad dressings do you prefer? *

Do you like Olives *

Do you like Dill Pickles? *

Is cream in your coffee or tea important? *

Are you going to prep all of your meals or will you be eating out? If yes, how many times per week do you usually eat out? *

What foods do you have in mind while on this program? *

Are you exercising currently? What are you doing & how often? *

Any questions or concerns that you want me to keep in mind while creating your plan? *

Any Additional Comments:

Email *

Phone Number *

How would you like us to contact you? (Please check your spam/junk folder for our email) *

What time of day works the best for you?

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