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MARK BRYCE
EXECUTIVE PERFORMANCE
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MB
MARK BRYCE
EXECUTIVE PERFORMANCE
Health Assessment Form
Help us prepare for your 90-minute deep dive consultation
Basic Information
Email *
Full Name *
Contact Number *
Age *
Location (City / Town) *
Motivation & Goals
Why do you really want to change your health? What's the driver / motivation? *
What do you believe is your biggest challenge when it comes to achieving your health goals? *
What are you looking to realistically achieve in 12-weeks? *
Nutrition
I understand I will be required to track my calories using MyFitnessPal for the duration of the coaching. This is essential! *
Please specify any dietary requirements (Allergies / Foods you dislike / Vegan etc / Religious Reasons)
What are some of the repeat staple meals you consume for breakfast / lunch / dinner / snacks including the frequency?
What food supermarket(s) do you shop at? List them below
Which habits would you like to improve the most?
Stop Snacking
Increase Protein Intake
Increase Greens Intake
Improving Hydration
Improving Sleep
Eat more wholefoods
Improve Gut Health (acid reflux, IBS, constipation)
Reduce Stress Levels
Training
Do you have access to a gym? If so, is it a home gym or a gym nearby? If a home gym, what equipment do you have?
How many workouts can you realistically commit to each week? (3)
1
7
How would you rate your current training experience:
Select your training experience
Beginner level
Intermediate level
Advanced level
What are your unhealthy vices? List what they are and the quantity per week
Do you have any injuries that will stop or limit you from doing certain exercises? Please list them below
Schedule
Do you have any holidays / travel commitments coming up in the next 12-weeks? If so, share them below with dates
What date would you be looking to ideally start the program?
Health & Lifestyle
How fit do you currently feel? (3/5)
Extremely Unfit
Extremely Fit
How many hours of sleep do you typically get per night? (7 hours)
1
10
Do you have any sleep conditions? (sleep apnea / using a CPAP / insomnia / narcolepsy)
In the past week, I woke up most days feeling:
Average
Tired
Average
Refreshed
Rate your typical stress levels: (5/10)
No Stress
Completely Stressed Out
Rate your typical energy levels:
Moderate
Low
Moderate
High
How much water on average are you drinking per day?
1-2 litres
Less than 1 litre
1-2 litres
2-3 litres
3+ litres
Physical Data
Height (cm/inches)
Current Weight (lbs/kg)
Target Weight (lbs/kg)
Current Waist (inches)
Target Waist Goal (inches)
Pictures (Optional)
Front Picture
Click to upload
Side Picture
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Rear Picture
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Home Gym Equipment
Click to upload
I confirm that I have read and agree to the privacy policy. I understand that Mark Bryce will collect and use my personal health information to provide coaching services, and that my data will be handled in accordance with GDPR regulations. *
Submit Health Assessment