Client Follow-up Questionnaire

Date

Name *

First

Last

1. What overall positive changes in your health and well-being have your noticed since starting our coaching relationship?

2. What goal have you met?

3. What area(s) would you like to focus on, shift, or approach differently in order to meet your goals?

4. What recommendations did you find helpful and would like to continue to use?

5. What are your main health or lifestyle concerns at this time?

6. What other comments would you like to share with me?

7. What kind of changes have you noticed in your weight?

8. What kind of changes have you noticed with your sleep?

9. What kind of changes have you noticed in your bowel movements? (constipation or diarrhea)

10. What kind of changes or differences are in your current exercise routine?

11. What kind of changes have you found in regard to your food and mood?

12. What food do you crave and what are the triggers?

What percentage of your foods do you prepare/cook at home? (Please select the closest match to you)

What is your diet like these days? Are you eating any particular diet plan?

What is your typical Breakfast? (Please include snacks, sweets and drinks)

What is your typical Lunch? (Please include snacks, sweets, and drinks)

What is your typical Dinner? (Please include snacks, sweets, and drinks)

What nutrition or lifestyle change would you like to learn more about?

What coaching plan best suits you right now?

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