ShedRx Coaching Intake Assessment

Welcome to your initial coaching intake assessment with ShedRx! Please take a moment to complete the following questions to help your coach best support your weight-loss journey.

Full Name *

Email *

What is Your Starting Weight?

What is Your Goal Weight?

Activity Level

What type of exercise do you do?

On a scale of 1-10 (1 being poor and 10 being perfect), Are you engaging in regular physical activity that feels good and aligns with your fitness goals?

How much water do you drink in a day?

How often do you eat out?

What is your alcohol consumption?

What type of diet do you follow (ex. vegan, vegetarian, paleo, gluten-free, etc)?

What type of food cravings do you have?

On a scale of 1-10 (1 being poor and 10 being perfect), how balanced and intentional are your eating habits, and how often do they align with your goals?

How many hours of sleep do you average per night?

How would you rate your sleep quality?

On a scale of 1-10 (1 being terrible and 10 being perfect), are you consistently prioritizing restful sleep to recharge your mind and body?

How Would You Rate Your Stress Levels?

On a scale of 1-10 (1 being terrible and 10 being perfect), are you maintaining meaningful relationships and fostering a sense of connection with others?

On a scale of 1-10 (1 being poor and 10 being perfect) how effectively are you managing stress?