Questionnaire

Please fill out the questionnaire below so I can better help you.

Please Provide a Wittle Information

First name

Last name

Phone

Age

Gender

Preferred Method of Communication

Phone

What inspired you to reach out to Wittle?

Nutrition and Eating Habits

On a typical day, how many meals do you eat?

Do you snack often between meals?

How many glasses of water do you drink per day?

Do you follow a specific eating plan? (Keto, vegan, intermittent fasting, etc.)

What are your biggest challenges when it comes to food?

Do you eat out often or cook at home?

Movement & Fitness

How often do you exercise per week?

What types of movement do you enjoy (walking, strength training, yoga, dancing, etc.)?

Do you currently have a workout routine?

What gets in the way of being active?

What would a successful fitness habit look like for you?

Sleep & Stress

On average, how many hours of sleep do you get?

Do you feel rested when you wake up?

How would you rate your current stress levels? (1 = low, 5 = high)

What are your biggest stressors?

How do you typically manage stress?

Mindset & Motivation

What does being “healthy” mean to you?

On a scale of 1–10, how motivated are you to make changes?

What has held you back in the past?

What would success look like for you 3 months from now?

Are you open to being held accountable (gently, of course)?

Medical & Lifestyle (Optional)

Any known medical conditions? (e.g. diabetes, high blood pressure)

Any medications or supplements?

Do you smoke or drink alcohol regularly?

Have you ever worked with a health coach or wellness program before?

Let’s Go!

What’s one small change you’re ready to start today?

Is there anything else you’d like me to know?

"Real food doesn’t have ingredients. Real food is ingredients."
— Jamie Oliver, Food Blogger