Assessment - Health Is Welch

Online Health Assessment

Please take a moment to complete your free online health assessment so Dr. Welch can learn more about your health and wellness needs. Please allow 3 business days for your report to be emailed to you. If you have any questions in the meantime please send an email to [email protected]. Thank you.

Name
First Last
Phone
Email
1. Tell me a little bit about yourself?
(Lets not be too serious, hey maybe I want to also be your friend ☺ )
2. What is your height?
3. What is your current weight?
4. What is your current % body fat?

An estimate is fine
5. What limitations do you have? (if any)
(ex. Could only workout in evenings or mornings, a health condition etc.)
6. What supplements are you taking, if any?
7. What are your short and long-term fitness goals?
8. Are you training consistently?
9. Please tell me a little bit about your training program?
10. What training programs have you tried in the past?
Has it work? Yes or No? If no, what didn’t you like about it?
11. Have you ever tried any of the following diets?
(Yes, I know there is a lot of bullshit diets out there Yikes!!!)
12. Are you currently a gym member?
- Yes
- No
13. Any food allergies or dietary restrictions? Please list.
14. Any injuries or other physical health conditions I should know about?
What monthly coaching plan are you most interested in?*
15. What caught your attention to sign-up or how did you hear about us?
Anything additional you want to include?
Upload Photos (optional)
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