FAT LOSS FOREVER: THE HABIT-BASED PROGRAMME

Your Name*

Your Email*

Gender*
MaleFemale

Date of birth:*

Home Address (For your free book!):*

Skype username (optional):

Phone number:*

Have you ever worked with an online coach before?*
YesNo

Please provide three photos (front, back, and side) in good lighting, with as much skin showing as possible.*
I have emailed my photos to daniel@danielharrod.com

Please provide four measurements (three times to get an average) at your waist (in line with your belly button), one inch below your belly button, your hips (round the biggest part of your glutes) and your chest (in line with your nipples).*
I have emailed my measurements to daniel@danielharrod.com

What are your overall goals? And why? (be as specific as possible – ‘to be healthy’ doesn’t quite cut it!)*

What are your biggest fitness struggles? (time, accountability, knowing what to do etc.)*

Why do you think you have not yet achieved the goals that you have set for yourself?*

Please list three prominent stressors you have in your life at this time (e.g. crazy work hours, lack of time to cook etc.)*

Can you describe a typical or recent day in your life that would help me understand your general lifestyle better? (e.g. work hours, looking after kids, watching TV in the evening, seeing friends and family for drinks etc.)*

What gym do you currently go to? Could you please provide a brief summary of all the equipment you have access to (e.g. dumbbells, barbells, machines, battle ropes, TRX, etc.*

What is your current training schedule (if at all): How many times a week do you train/what do you usually do (weights/cardio)/any current set/rep schemes?*

How ‘active’ are you during a typical day? (e.g. a job that involves a lot of moving about, how many steps per day on average etc.)*

What is your current eating schedule (roughly)? (e.g. how many meals/snacks do you have a day and what times usually?)*

Have you ever had experience with tracking calories and/or macronutrients (protein, carbs, fat etc.)? If so, provide as much detail as possible.*

Have you ever undertaken any specific diets or weight loss classes in recent years? (e.g. slimming world, weightwatchers, dukan, ketogenic etc.)*

Do you have any dietary requirements? (e.g. vegetarian, gluten-free etc.)*

Are you currently taking any supplements? (e.g. whey protein etc.)*

Any injuries or health conditions I should know about?*

If yes, does this prevent you from performing certain exercises or movements?

On a scale of 1-10, how happy are you with your body at the moment? (10 being perfectly happy, 1 not happy at all)*

On a scale of 1-10 how determined are you to achieve your goal? (10 being fully committed, 1 being not committed at all)*