Pre-coaching Questionnaire

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Firstname

Date

Year of birth

Age

1. When is it easiest for you to skip a meal? In the morning, at lunchtime, or in the evening?

2. How many times a day do you eat, and what do you eat?

3. What allergies do you know about?

4. Do you eat meat? If so, how often a week?

5. What dairy products do you eat? How many times a week?

6. What grains do you eat? How much per week?

7. How many times a week do you eat at restaurants?

8. How many times a week do you go shopping?

9. Do you drink coffee or energy drinks? What kind of tea do you drink?

10. Do you drink carbonated beverages? Alcohol?

11. Do you often get cravings? For what? Something sweet, something salty—or just a lot of food?

12. Do you smoke? What medications are you taking?

13. Do you watch TV in the evenings? How much TV do you watch (in hours per week)?

14. How long do you sleep, when do you wake up, and when do you go to bed? Do you sleep through the night?

15. Do you wake up with or without an alarm clock? How do you feel in the morning? How long does it take you to get going?

16. What sports do you play? How many times a week?

17. What brings you joy—and what causes you stress?

According to the original form, this question is intended to promote self-awareness and slow down the process, and does not necessarily have to be answered in writing.

18. What is a major burden for you?

According to the original form, this question is intended to promote self-awareness and slow down the process, and does not necessarily have to be answered in writing.

Note: According to the original form, the last two questions do not need to be answered in writing. They are intended to promote self-awareness and slow down the process.

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Joti Urban • Yogic Wisdom Now