Reset program screening form

Reset 4 week program

"Reducing brain fog, bloating & weight - to feel good again"
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What are your top 3 reasons for wanting to partake in the Reset program?
What diets/eating plans or health programs have you tackled before?
What has worked for you and why? (enjoyed the food, organized, variety of workouts.)
What hasn't worked for you and why (to complicated, no family support, workouts too hard, too much running, lack of support)
What is your main concern about your health at the moment?
What are you afraid of when it comes to diet and exercise programs?
eg. do you not enjoy stiffness after training, do you get anxiety feeling you have to keep up with others in the gym, do you self sabotage your food after seeing good results, do you overthink the food aspect?
What is your current diet like? Is it full of a variety of food, or do you eat the same sort of food each week? Give example of a daily food diary.
Please do not alter anything - I need to know what you currently have (there is no judgement in this program).
On a scale of 1-10, how much are you willing to commit to Reset? (1 not being willing to change - 10 being definitely willing)
Do you sleep well? Do you work shift work? etc
If you wake during the night please what time do you wake, do you fall back to sleep easily? Do you get to sleep easily, do you wake tired?
What do you want most out of this program?.
Out of the 4 pillars of health, what do you need to work on the most?

SleepStressNutritionMovement/exercise
What type of essential oil blend would you like to support you through this program and beyond.. select two..

UpliftingMood swingsRestful/sleepReduce AnxietyCease cravingsPMSDigestion/Bolating
What is your best learning method?

ReadingListeningWatchingOther
These are my group times in the gym - please select what times suit you.

Monday 6amMonday 8.30am (after school drop off)Monday 4.30pm onwardsWednesday 6amWednesday 8.30am (after school drop off)Wednesday 4.30pm onwardsFriday 6amFriday 8.30am (after school drop off)
If you have any special requests/concerns/prior injuries or anything else I need to know about please enter these below.
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Reset 4 week program

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