THE Platinum LIFESTYLE Triage Questionnaire

Please take the time to complete this form. It will help us assess how we can help with your transformation.

The Triage Consultation Questionnaire

To assess what specifically needs to be changed in clients lifestyle to get the results they want.
  • Wrote down and kept a diary of your food and liquid intake
  • lose 1 kg, be able to run faster, lift heavier, learn something new, feel better, more energy, have more confidence?
    Tell where you prefer, we can get results with either just tell me what suits you. If you little time and a family getting to the gym might not be possible.
  • 0 if you don’t go to the gym
  • 0 if you don’t train outside the gym
  • Tell me more about you

    By getting to know more about your lifestyle & habits, I can take better care of you and make sure mentoring is a great fit for your goals and individual needs.
  • less than 5 mins to eat a meal,
    Click all that apply
  • Make a list of all the things you think about relating to your health, fitness & lifestyle.
  • Pick 1 or 2 that really sticks out for you.
  • Write about “WHY” the above thing is so important
  • Online coaching, personal training, weight watcher, keto, intermittent fasting etc
  • Say nothing if nothing worked well.
  • Type “NOTHING” if you want.
  • Think, if you could click your fingers where would you wanna be in 12 months?
  • Time, education, busyness?
  • Please enter a number from 1 to 10.
    1 being awful and 10 being super amazing
  • Type none if none
    Cleaning, walking to work, gardening, active hobbies like building cars.
  • Please enter a number from 1 to 10.
  • If yes please explain
  • Type No but if YES please explain.
  • 1 being I feel tired n shitty, 10 being super healthy & on top of the world
  • Please enter a number from 1 to 10.
    1 being, dam I need to get a life I am so stressed, 10, I am super organised and making the most of my time very calm.
  • Please enter a number from 1 to 10.
    1 being, I’m gonna pull my hair out, 10, I’m so calm and collected.

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