Matt Motley / Intake

Before your assessment

Fill this in before you meet, so your 45 minutes go to your plan rather than to paperwork. It takes about ten minutes. Skip anything you would rather talk about in person.

Your answers go directly to Matt. This website does not store them. Privacy policy

About you

Full name (required)

Email (required)

Age

What are your current health goals? What would you like to be different three months from now? (required)

What have you already tried, and what got in the way?

Health and safety

Coaches do not diagnose or treat. This tells your coach what to stay clear of, and when something belongs with your doctor instead.

Do you have any diagnosed health conditions that your coach should know about?

What prescription medications do you currently take?

What supplements or vitamins do you currently take?

Has a physician told you to avoid or limit anything, such as certain foods, types of exercise, or caffeine?

Nutrition

What did you eat and drink yesterday, from when you woke up until you went to bed? (required)

Rough is fine. A typical day is more useful than a good one.

How many meals do you eat on a typical day?

How often do you eat vegetables or fruit?

Do you follow a particular way of eating, or have any food allergies or restrictions?

Vegetarian, gluten-free, food allergies, religious practice, and so on.

Do you regularly experience digestive discomfort, such as bloating, irregularity, or reflux?

Exercise

What does a normal week of physical activity look like for you right now? (required)

How often do you do strength or resistance training?

If you track your steps, roughly how many do you take on a typical day?

Do you have any injuries or physical limitations that affect how you move or exercise?

Sleep & Mindfulness

How many hours of sleep do you get on a typical night?

How rested do you usually feel when you wake up?

How often do you use a phone, tablet, computer, or TV in the hour before bed?

How would you rate your stress level over the past month?

What, if anything, helps you relax or unwind?

Hydration

How much plain water do you drink on a typical day?

How much coffee, tea, soda, alcohol, or energy drinks do you usually have, and how often?

Anything else

Is there anything else you would like your coach to know before you meet?

Before you send

Wellness coaching is not medical care. Nothing here is medical advice, diagnosis, or treatment, and it does not replace your physician. Talk to your doctor before changing your diet, exercise, or supplement routine — especially if you take prescription medication or manage a chronic condition.

I understand that wellness coaching is not medical care, and that Matt does not diagnose, treat, or prescribe.

I agree to send these answers to Matt Motley to prepare for my coaching sessions, as described in the privacy policy.

I am 18 or older.

Before your assessment

Thank you. Matt has your answers.