Coaching Pre-Screen Questionnaire - LA Fit

What to expect at your first appointment

At your first Personalised Health Coaching appointment we will get to know you and why you’re here. We’ll take your body measurements and health history to determine your Unique Health Profile using a personalised health assessment tool called ph360. We’ll explain the science, the program, help you set your first goal and stay accountable!

At least 24 hours before your appointment

Download the Shae app on Apple or Android
Create your profile and enter the unique token we send you.

To avoid delays at your appointment, please let us know immediately if you have any technical issues!

Before arrival

Wear light, form fitting clothing
Complete the pre-assessment questionnaire below

If you have any questions or concerns about the profiling process or this form please reach out.

Coaching Pre-Screen Questionnaire

Name*
Email
LA Fit workout plan*
In a regular week, how many classes do you intend to do at LA Fit?
Other exercise / activity regularly done outside of LA Fit*
Include type, frequency and length of session (eg 2 x gym x 1hr sessions, 1 x 1hr run)
Goals
What are your health and wellbeing goals for the next 3 months?*
Choose any that are applicable
- Improve cardio
- Weight loss
- Stress relief
- Increase strength
- Improve sleep
- Increase energy
- Increase stamina / endurance
- Improve self confidence
- Greater connection with a community
Have you got a specific goal in mind?
How you fuel your body
Do you believe that how you fuel your body affects your overall wellbeing?*
How have you felt over the last 7 days?
My stress level is*
1 (Low) 2 3 4 5 (High)
At times, I feel anxious / depressed*
1 (A little) 2 3 4 5 (A lot)
I sleep*
1 (Not well) 2 3 4 5 (Really well)
My self-esteem is*
1 (Low) 2 3 4 5 (High)
I love my body*
1 (A little) 2 3 4 5 (A lot)
I love my life*
1 (A little) 2 3 4 5 (A lot)
I feel happy*
1 (A little) 2 3 4 5 (A lot)
I can do anything I put my mind to*
1 (I disagree) 2 3 4 5 (I agree)
I feel inspired and motivated*
1 (Not really) 2 3 4 5 (A lot)
I feel that I have a lot of energy that lasts through the day*
1 (I disagree) 2 3 4 5 (I agree)