First Name *

Last Name *

Email Address *

Which store is your wellness appointment scheduled at? *

Select your Wellness Coach *

How old are you? *

How tall are you? (inches) *

What is your current weight? (lbs.) *If you would like to weigh in at your appointment, you may leave this part blank

Gender *

Do you have any preexisting medical conditions that you think your coach should be aware of (ex: diabetes, heart conditions, etc.)? *

Yes
No

Please explain.. *

Do you have any dietary restrictions (vegetarian, gluten-free, etc.) or food allergies that your coach should be made aware of? *

Yes
No

Please list any dietary restrictions/food allergies here: *

What is your overall health goal? *

Exaplain your goal here: *

What is your motivation for reaching this goal? (aka your 'why') *

What has been the biggest obstacle/challenge with reaching your goal? *

What other programs or coaching (if any) have you tried? *

How would you best describe your current lifestyle? *

How would you best describe your current phyical activity level? *

What type of physical activity do you ENJOY doing? (Walking the dog, swimming, lifting weights, etc.) *

Which of the following best describes your current eating schedule/habits? *

How many days a week do you typically eat out at a restaurant or order takeout? *

How many days a week do you or a family member cook at home? *

What does a typical breakfast look like for you? Not your best day or your worst day, just the normal, average day. *

What does a typical lunch look like for you? *

What does a typical dinner look like for you? *

Do you snack throughout the day? *

Yes
No

What do you typically snack on? *

Do you drink alcohol? *

Yes
No

What type of alcohol and how often? *

Do you drink any coffe/tea? *

Coffee
Tea
Both
No

How many cups a day? *

How do your take you coffee? *

How many cups a day? *

How do your take your tea? *

How many cups a day? *

How do your take your coffee and tea? *

How many 8-ounce glasses of water do you typically drink in a day? *

How many days of the week do you find yourself waking up feeling restful from your previous night's sleep? *

How motivated do you currently feel about working towards your wellness goal? *

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Thanks for getting in touch!

Tampa Bay’s Fitlife Foods Set to Open New Stores as Business Booms During Pandemic

“We’ve done more innovation in 2020 than any other year in the history of our company,” - CEO & Founder, David Osterweil.

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