WEIGHT LOSS | Warriorbootcamp

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1. What would you like to accomplish with your health? This could be weight-loss, improved sleep, better response to stress, etc. *

3. Can you tell me about a time in your life when you were healthier? What has changed between then and now? *

*Lithium: The healthcare provider may wish to adjust frequency of lab work for the Client and monitor. Thyroid Medications: The healthcare provider may wish to monitor thyroid hormone levels while the Client is on the Program and adjust medication. Coumadin (Warfarin): The healthcare provider may wish to review food choices, conduct lab work and/or adjust medication.

How would you describe the quality of your sleep?

MOTION How would you describe the quantity & quality of the activity you do each week?

How many days a week do you exercise? (0 - 7 days) *

MIND On a scale of 1-10, how fulfilled are you? *

What area of your life tends to be the biggest stress for you?

On a scale of 1-10, how much do you enjoy what you do? *

When do you eat your first meal of the day?

How many ounces of water do you drink per day? *

If so, how often and how much?

Height *

What would you consider to be a healthy weight for you? *

What has been difficult for you about losing and maintaining weight? *

Is there anyone in your life who would like to get healthy with you? *

2. What is your main motivation for wanting to make changes to your health? Relationships, activities, how you will feel, etc *

4. Tell me about your health: Do you have any allergies or medical conditions that could influence which Program we choose? *

STEP 2: DAILY ROUTINE & HABITS SLEEP & ENERGY How many hours of sleep do you get in a typical night?

On a scale of 1-10, what is your energy level throughout the day? *

How many hours a day do you sit?

What types of physical activity do you enjoy?

On a scale of 1-10, how much do you worry?

What do you do for work? *

FOOD & HYDRATION How many meals and snacks do you eat per day? *

How many times a week do you eat out? And where?

Do you drink other beverages? Coffee, soda, alcohol, tea, etc.

WEIGHT MANAGEMENT Age *

How much do you currently weigh? *

Have you tried to lose weight in the past? *

SURROUNDINGS On a scale of 1-10, how healthy would you rate your surroundings? (This includes: healthy friendships, supportive family, keep junk food in the house, etc *

Is there anyone in your life who would like to get healthy with you? *

Coach Kirk Carlson

Total Workout Pro Health Evaluation

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