Are You Ready To Get Fit

Hello, Fitness Bestie! 🌟

Welcome to 360 Life Changes Fitness Coach Prescreening. Take a few moments to fill out this “Get Fit Questionnaire” and we’ll reach back out to you shortly after reviewing your responses.

IMPORTANT DISCLAIMER: This screening tool does not provide medical advice, nor does it substitute for advice from qualified medical professionals. No warranty of safety should result from its use. 360 Life Changes cannot accept responsibility for any loss, damage, or injury that may arise from acting on information contained in this tool.

360 LC Peer Mentor Coaching Orientation Welcome to your

ransformative journey! 🌟 Before your first session with your life coach, you’ll complete three essential questionnaires that form the foundation of your personalized coaching experience: Required Pre-Session Work:

Past Life Shadows Questionnaire – Reflect on past experiences and traumas that may be influencing your current lifePresent Life Present Que stionnaire – Evaluate your current situation, challenges, and immediate needs Future Life Goals Questionnaire – Define your aspirations, dreams, and long-term objectives

What You’ll Receive:

Your own personalized workbook (provided or downloadable from website)
Access to complete questionnaires online

What to Bring:

Your own pen/pencil
Open mind and willingness to grow

Program Structure:
This is part of our comprehensive yearly system with three interconnected 4-month programs that must be completed in order, designed to provide directive guidance and healing for complete lifestyle transformation.
Your Investment:

Phone Sessions: 4 months, 8 calls – $500
In-Person Sessions: 4 months, 8 sessions – $1,300

Your life coach will use your questionnaire responses to create a personalized roadmap for your transformation journey.
Ready to become your best self? Your transformation starts with honest self-reflection! 💪✨

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PART 1: BASIC INFORMATION

Full Name:

Email:

Phone:

Best time to contact you:

How did you hear about us?

Currently employed

Yes No

Have you purchased the 360 Deck?

Yes No

Height

Weight

Address

City

State

ZIP

PART 2: LIFESTYLE & HEALTH
Work & Activity:

Occupation:

Job activity level

Sedentary Moderate High

Work schedule

Days Nights

Health Information:
Current medications affecting workout performance:

Any injuries or physical limitations

Do you have diabetes, asthma, or blood pressure issues?

Current smoker

Yes No

Food allergies:

Current Activity
Physical activities outside work/gym

Currently exercising regularly

Yes No

If yes, what do you currently do?

PART 3: COACHING GOALS

Rate your readiness for change (1-10)

Primary fitness goal

Timeline for achieving goals

Training frequency you're willing to commit

One motivational word that represents your drive:

Preferences
Preferred workout times

Morning Mid-day Afternoon Evening

Currently on a diet:

Yes No

Had a personal trainer before

Yes No

PART 4: PROGRAM COMMITMENT

Program Selection:

Commitment Questions:

Can you commit to 5-day program (Mon-Fri) plus Saturday chit-chat and Sunday fitness card spread?

Yes No

Can you attend both in-person and digital workouts?

Yes No

Will you follow/create a diet plan?

Yes No

Can you complete digital fitness/nutrition booklets?

Yes No

Understanding
Type "YES I UNDERSTAND" to confirm you know this is a coaching program requiring your active

participation to achieve and maintain goals

PART 5: FINAL DETAILS

Why are you choosing 360 Life Changes?

What would you like your fitness coach to know?

What are your expectations of us as your fitness coach?

Next Steps

The Fitness Deck is required before starting your program or you can purchase a fitness card

reading separately online.

Ready to transform your life? Let’s do this together!

CONTACT INFO:
(561) 389-5974
bestpart@360lifechanges.info
360lifechanges.com

Hello, Fitness Bestie! Welcome to 360 life changes Fitness Coach prescreen. Take a few moments to Fill out the “Get Fit Questionnaire” and we will reach back out to you shortly after we review your responses. This screening tool does not provide advice on a particular matter, nor does it substitute for advice from an appropriately qualified medical professional. No warranty of safety should result from its use. The screening system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by 360 life changes for any loss, damage, or injury that may arise from any person acting on any statement or information contained in this tool.

Basic client information

Full Name

Sex

Best time to contact you?

How did you hear about us?

Do you currently work: Yes or No

Have you purchased the 360 Deck?

Height

Weight

Home Address

City

ZIP

State

Cell Phone

Home Phone

Part 2 Lifestyle information: What do you do for a living?

What’s the activity level at your job?

None (seated only) Moderate (light activity) High (heavy labor)

Do you work Days or nights?

DAYS NIGHT

Please list the physical activities that you participate in outside of the gym and outside of work

Are you on any medication that will hinder your workout performance?

If you are on any medications please list them

What additional therapies are being undertaken for the given health problems?

If you have any injures list them

What additional therapies are being undertaken for the given injury?

Are you experiencing any stresses or motivational problems?

Yes No

Do you suffer from diabetes asthma high or low blood pressure?

If so please list

Are you a current cigarette smoker?

Yes No

What kind of diet will you be interested in while completing the program: Select down below?

Low fat Low carb High protein Vegetarian No special diet

Are you allergic to any foods? Please list.

Part 4 Coaching Goals: Please rate your readiness for change (1. Not active/ Not Ready, 5. Active but need a boost, 10. Ready to get it on and popping)

What’s your goal with your fitness coach?

TimeLine for achieving goals

How often are you willing to train on your personal time to reach your goal?

Please type one motivational word that represents the level it takes for you to reach your goal. (Ex. Endurance, courage).

Are you currently exercising regularly? If yes what do you do currently?

Yes No

Have you had a personal trainer before?

At what times during the day would you prefer to do the 1:1 fitness coaching or group fitness coaching?

Morning Mid-day Afternoon Evening

Are you currently on a diet? yes or no

Yes No

How often do you want to commit to the 1:1 personal coaching or Group Coaching? (note: all programs are 5 days Monday-Friday. Saturday chit chat and Sunday Fitness card spread). Are you able to commit as outlined above? yes or no

What is your expectation of us as your fitness coach? Will you be able to make it to and from the workout station, as well attend digital workout? Will you be able to follow a diet plan or create a diet plan?

Do you know that this program is Fitness /Health coaching Program that means; you will have to do the work to achieve your goals and maintain your goals? Type ” yes I understand”

Part 5 : Why us? Why are you choosing the 360 life changes fitness program?

Which programs do you want to sign up for: Please add 1:1 personal coaching if you’re interested in personal coaching needs.

Sunny Delight Earthy Flower Moon Goddess 1:1 personal coaching

What will you like to inform your fitness coach?

Are you able to complete 360 life changes fitness/ nutrition booklet by digital downloads? Yes or No?

Yes No

If no explain why?

Are You Ready To Get Fit

Hello, Fitness Bestie! 🌟

Next Steps

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