Please fill the form as complete as possible, this will make the intake more effective.
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Fist name
Last name
Email
Phone number
Date of birth
Hight
Weight
Gender
men
woman
other
Current living situation (multiple possible)
Single
Partner
Children
Living at parents
Job
What does a working week look like for you?
How many hours of sleep per night?
Motivation (10 is highly motivated)
1
2
3
4
5
6
7
8
9
10
Energy level (10 is High energy)
1
2
3
4
5
6
7
8
9
10
Stress level (10 is a lot of stress)
1
2
3
4
5
6
7
8
9
10
Alcohol (glasses per week )
0
1
2
3
4
5
6
7
8
9
10
10+
cigarettes per day
0
1
2
3
4
5
6
7
8
9
10
10+
What is your goal?
Why do you want to reach these goals?
What have you done to reach these goals?
Are you ready to really change your life and mindset
Yes
Do you have experience with
Weightlifting
endurance sports
Sport
Diet
Meditation
Yoga
Breathwork
Other health activities
Describe your experience
How many times a week can you exercise?
1
2
3
4
5
6
7
Injuries
This question is for women. Is your cycle regular and do you have many or few complaints during menstruation?
Medical condition
Do you have allergies
Are you
Vegetarian
Vegan
Do you eat organic
Yes
No
Sometimes
Number of times eating out/takeaway per week
0
1
2
3
4
5
6
7
8
9
10
10+
Your 3 favorite meals
Do you use supplements?
Is there anything else I should know?
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