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Accelerator Coach
Accelerator Kickstart
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Name
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First
Last
Current Age
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Height (cm)
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Weight (kg)
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Body Fat %
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In your own words, what are your goals for this Accelerator? (don’t include specific targets, more broad goals, such as ‘lose weight/fat’.)
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Have you ever followed a diet/tried weight loss methods in the past?
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Yes
No
If Yes, were your previous weight loss methods successful?
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Yes
No
If No, what problems/issues/struggles did you have with weight loss methods in the past?
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Consistency/motivation
Too much hassle
Not knowing what to eat
Lack of accountability
Other
Which problems did you have?
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Are you willing and able to track food intake through the MyFitnessPal app (or similar)?
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Yes
No
If No, Why not?
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Too much hard work
I don’t understand how to use these
I need something simpler
Other
Why are you unable to track food intake through MyFitnessPal app (or similar)?
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Do you follow a specific diet at the moment?
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No
Vegetarian
Vegan
Pescetarian
Other
Which diet do you follow at the moment?
Have you ever been diagnosed with an eating disorder?
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Yes
No
How many gym sessions do you currently average per week?
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0-2
3-4
5+
How many steps do you currently average per day? (30 mins brisk walking = 3,000 steps).
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How many sessions a week can you commit to during the accelerator?
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How many hours sleep do you typically average per night?
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Less than 5
5-7
7-9
9+
What time do you typically go to sleep?
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Hours
:
Minutes
AM
PM
AM/PM
How much alcohol do you typically consume per week? (1 bottle of beer = 1.7 units, 1 pint of lager/beer/cider (3.6%) = 2 units, 1 standard glass of wine (12%) = 2.1 units, 1 standard shot of spirits (40%) = 1.4 units.
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