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Blank Form (#5)
WHO YOU ARE
Full Name:
Time Zone/City
Role
Age
Email
Phone Number
CURRENT STATE
Rate each area on a scale of 1 -10 (1 = major work , 10 =performing at your best)
Physical Fitness
Current Score (1-10)
1
2
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4
5
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7
8
9
10
What would a 10 look like for you?
Nutritional Habits
Current Score (1-10)
1
2
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7
8
9
10
What would a 10 look like for you?
Mental Focus & Discipline
Current Score (1-10)
1
2
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5
6
7
8
9
10
What would a 10 look like for you?
Emotional Health
Current Score (1-10)
1
2
3
4
5
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7
8
9
10
What would a 10 look like for you?
Financial Stability
Current Score (1-10)
1
2
3
4
5
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7
8
9
10
What would a 10 look like for you?
Spiritual / Purpose Alignment
Current Score (1-10)
1
2
3
4
5
6
7
8
9
10
What would a 10 look like for you?
Goals
What is your #1 goal for the next 90 days?
What is your biggest obstacle right now?
What have you already tried? Why didn't it work?
What does success look like in 6 month?
Current workout frequency (days per week):
HABITS
What time of day are you most focused and available?
How many hours per week can you commit to this program?
< 4hours
5-8 hours
9+ hours
Current sleep average (hours per night):
Current daily water intake(Cups or Gallons):
Describe a typical day from wake-up to bedtime:
On a scale of 1-10 , how accountable are you to yourself right now?
1
2
3
4
5
6
7
8
9
10
What's getting in the way of your consistency most often?
Work / Schedule
Motivation
Stress or emotional state
Lack of clear plan
Other
What does accountability mean to you?
Are you ready to commit fully not just physically, but mentally and emotionally?
Yes
Almost i need
No(let's reschedule)
Anything else you want me to know before we start?
What should I know about you that would make this accountability successful?
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