client assessment

Initial Client Assessment Questionnaire:

Please fill out all fields as completely as possible. This information helps me better understand your background, goals, and how I can help you succeed.
Name *
Birthday *
Current Activity Level *
(1-horrible, 10-exceptional)
Who lives with you?
Check all that apply.
Who does the grocery shopping in your home? *
(1-not at all, 10-they support me 100%)
(1-not at all, 10-I am 100% willing to do anything)