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GOALS WORKSHEET

Goals Worksheet

Name*
First Last
Email*
Phone*
What is the best time to reach you?*
Facebook URL
Describe your CURRENT health and fitness level and how you feel now.*
PAINT a detailed picture of you at your IDEAL health and fitness level and how you will feel when you reach this point.*
Do you have a family history of health conditions such as heart disease or diabetes?*
What is your greatest concern or fear when it comes to your future health and fitness?*
Describe your current fitness level.
- Completely out of shape with little to no exercise
- Workout occassionally
- Workout 4-6 days per week - but need a challenge & a change!
- I have the fitness and functionality of an elite athlete and am completely happy with where I am
Which best describes your overall weight loss goals?*
- Tone up and lose about 5-10 pounds. Lose that last little bit of fluff to be my best.
- Lose between 10-25 pounds. I have some work to do.
- Lose more than 25 pounds. Ready for a NEW & Improved ME!
- Gain lean muscle. Ready to take my fitness to the next level!
Please list the habits you would like to change.*
How long have you wanted to make these changes?*
What type of exercise do you ENJOY?*
- Pure Cardio
- Weight Training
- Balanced - Weight Training, Cardio, Flexibility
- Never really enjoyed exercising, but ready to start.
My Commitment Level is:*
- Need Motivation & Accountability to get moving
- Enjoy working out, don't really have enough time. Ready to learn how to make it work!
- Willing to give it 100% for a TOTAL BODY Transformation!
What have you tried in the past to improve your fitness level?*
What external factors have you allowed to derail you in the past?*
- Time
- Money
- Lack of facility or equipment
- Procrastination
- Lack of support
- Other
In your own opinion, why did you fail to "stick with it"?*
- Discipline
- Knowledge
- Experience
- Accountability
- Lack of expertise
Tell me about your support system.
How would you describe your energy levels?*
- Bouncing off walls
- Steady energy throughout the day
- Start out great but hit a wall mid-day.
- Often tired
How often do you find yourself reaching for coffee or an energy drink?
- Never
- Occassionally
- Once or twice a day
- Several times a day
How many hours of sleep do you get a night?*
- 4-5 Hours
- 6-7 Hours
- 8 Hours or more
What is your CURRENT activity level, NOT including any workouts you may be doing?*
- Inactive (ex. desk job)
- Moderate (ex. server in a restaurant)
- Active (ex. construction worker)
There are MANY ways to lose weight, but that is not the same thing as improving your health. The ONLY WAY to improve your HEALTH and FITNESS and create habits that will serve you FOR LIFE is by FOCUSING both your HEART and MIND—by making a shift in the way you THINK and FEEL about what it takes to be healthy—to be FULLY ALIVE. MOST importantly, you have to change the way you think and feel about YOURSELF and your potential! So, my question to you is this... Where are you at currently in your life and WHY are you READY and WILLING to do what it takes to CHANGE!?*

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WELCOME!

I’m Deryl. I’m a former tired, overweight, stressed-out dad turned certified trainer and Integrative Nutrition Health Coach (INHC). My wife, Tracy, is a Registered Nurse and full-time home-schooling mom of four. Together, we help people live life as God intended—fully alive!

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Deryl Duer
Author, Speaker, & Health Coach
(830) 743-7635
derylwduer@gmail.com

**These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.