Beyond Nutrition Balanced Solutions Life Coach Executive Coach Individual and Corporate Wellness Nutritionist Health Food Healthy Living Organization Personal Training

Personal Information:

Name: Address: Email Address How often do you check email? Best number to reach you:

Age: Date of Birth mm/dd/yyyy: Place of birth:

Social Information:

Relationship Status: Do you have children: If so, how many? Grandchildren: If so, how many? Pets:

Are There Any Conflicts At Home? Pressures From Relatives? Do You Spend Adequate Time With Family/Friends? Are Your Finances In Order?

Career:

Occupation: Hours Per Week of Work? How Long is Your Commute? Is Your Role Demanding? Do You Have an Admin, Project Manager, Other Staff? Do You Delegate? Do You Get The Recognition You Deserve?

Are You Compensated Accordingly? Does Your Job Pay The Bills? Are You Passionate About Your Job? How Are Your Work Relationships? Is Your Job Secure? When You Are Stressed At Work What Calms You Down? Do You Take Breaks During the Day? Do You Have Your “Own World” Near Your Office? Do You Take Sick Days?

Fitness:

What Role Does Exercise Play in Your Life? Is your energy level low, med, or high?

What Is Your Workout Routine? What Is Your Workout Schedule?

Self Care:

What Things Do You Do For Fun? Do You Leave Work At The Office? Do You Eat Breakfast? Are Your Food Choices Healthy? Do You Cook? Do You Maintain a Desirable Weight?

Do You Sleep Well? How Many Hours? Do You Wake Up At Night? Are Your Aware Of Tension In Your Body? What Do You Do To Relax? Do You Take Time Off From Work? Do You Worry? Do You Get Annual Checkups?

Time Management (Personal & Professional):

Do You Have A Clear, Prioritized Agenda? Do You Have Annual Goals? Do You Keep Task Lists? Do You Delegate? Do You Have a Filing, Calendar, Email System? If Yes, Is Your Filing and Calendar System Paper-Based or Electronic?

Do You Over-Commit? Do You Have An Efficient Routine? Is Your Environment Neat, Serene, Organized?

Additional Information: How Did You Hear About Marianne and BNBS? Anything Else You Want to Share? What are your top 3 health/life goals?