Intake 8-Week Program – DEBsWAY CRM

Personal information

First name

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Last name

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Email address

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Phone number

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Date of birth

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Height (cm)

Work structure

What is your work structure?

Office

Hybrid

Frequently on the move or travelling

Working from home

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Home situation

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Your goal

What do you want to achieve in the next 8 weeks?

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When we look back after 8 weeks — what needs to have concretely changed?

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Why is this important to you right now?

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Previous experience

Have you tried to lose weight or improve your health before? What did you do?

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What worked well for you?

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Current nutrition

Walk me through a typical weekday from morning to evening — what do you eat and drink?

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What does a typical weekend day look like?

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How many meals do you have per day?

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Do you snack? If so — what and when?

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Do you drink alcohol? If so — what and how often?

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How often do you eat out per week?

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Nutritional context

Do you follow a particular way of eating?

No specific pattern

Vegetarian

Vegan

Religiously or culturally determined

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Allergies or intolerances?

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Foods you avoid?

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Movement

How active are you currently?

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Do you play sports or train? What and how often?

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What is your experience with strength training?

No experience

Basic

Regular

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Injuries or physical limitations?

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Daily structure

Usual times to get up and go to sleep?

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How do you sleep in general?

Well

Reasonably

Not so well

Varies

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When do you feel most energetic and when least?

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How busy are your workdays usually?

Calm

Moderate

Busy

Very busy

Varies

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Environment

Who do you live with?

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Who usually cooks?

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How much support do you feel from those around you?

Little

Some

A lot

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Can you briefly elaborate on this?

Consistency and challenges

At what moments does it become harder to make good choices?

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What situations throw off your routine?

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Expectations

What do you expect from me during this programme?

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Where do you see your biggest challenge?

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How much time can you set aside per week?

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Practical information

Do you have supplementary health insurance that covers nutritional counselling?

Yes

No

I don't know

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Which insurer?

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Which supplementary policy?

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Finally

Anything else important to share?

Referral code — were you referred by someone?

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I have read and agree to the General Terms & Conditions.

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I have read and agree to the Privacy & Cookies Policy.

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I have read and agree to the Client Responsibility.

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