Mind and Body Questionnaire

How old are you? :*
Your current weight:*
Your Gender:*
Where did you hear about us? :
Other:

How many times a week do you do each of the following? :

Lift Weights:
Endurance:
Team Sports:
Yoga/Pilates:
CrossFit Classes/Bootcamp Classes/Body Pump:
Other activity:

How long have you been at your current weight?
How much weight do you want to lose?*
Why have you decided to make changes now? How do you feel in your current situation?*
Why do you think you have failed in the past? :*
Is there anything at the moment that would stop you pursuing your health, fitness and weight loss goals at present? :
What is the number one goal you would like to achieve in the next 6 months? What will achieving this goal do for you physically, mentally and emotionally? :*
Out of 10, what is your present level of commitment to address your health and reach these goals that relate to your health, weight and lifestyle? (10 being 100% committed)
Do you have the finances available to commit to a mentoring program?*
Name:*
E-mail:*

Best contact number:*

BMR Calculator

You use energy no matter what you’re doing, even when sleeping. The simple calculator below will calculate your Basal Metabolic Rate (BMR) – the number of calories you’d burn if you did nothing and stayed in bed all day.