Registration questionnaire Let’s do this together! Email Address hello@jgwm.co.uk Name Email Address Address 1 Address 2 Town County Postcode Height Weight What is your main objective? What is your main objective?Weight lossWeight gainImprove overall health and fitnessNutrition help and advice Where are you on the Motivation Scale? Where are you on the Motivation Scale?1 - Not very234567891- Extremely Motivated How would you rate your current energy levels? How would you rate your current energy levels?1 - Very little2345678910 - Full of energy How would you rate your current stress levels? How would you rate your current stress levels?1 - Very little2345678910 - Totally stressed How many hours sleep do you get per night? (On average) Which diet plans have you tried before? Which diet plans have you tried before? Weight Watchers Slimming World Atkins Slimfast Cambridge Diet 5:2 Paleo Juice Plus Pinch of Nom Detox Diet Hairy Dieters Herbalife Other If 'other' please detail here. Have you tracked calories before? Have you tracked calories before? Yes No Have you tracked macros before? Have you tracked macros before? Yes No What are your favourite foods? Do you have any dietary requirements/food allergies Do you have any dietary requirements/food allergies Yes No If 'Yes', please details here How much water do you drink per day? How much water do you drink per day?Less than 500ml1 Litre2 Litres Do you track your steps per day? Do you track your steps per day? Yes No How do you track your steps? What is your favourite kind of exercise/activity? (E.g swimming, walking, cycling, jogging etc.) What is your current activity level? What is your current activity level?SedentarySome activityFairly activeVery active Do you have any pre-existing injuries? Do you have any pre-existing injuries? Yes No If yes, please list Do you have any medical conditions? Do you have any medical conditions? Yes No If yes, please list What is your long-term goal? There is a financial commitment upon signing up to my JG For Life Plan. Are you willing to invest in yourself right now? There is a financial commitment upon signing up to my JG For Life Plan. Are you willing to invest in yourself right now? Yes No Where did you hear about me? Where did you hear about me?ReferralFacebookInstagramGoogle Submit
