Test - Andres Preschel

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Disclaimer(Required)

The Company strongly recommends that you consult with your physician before beginning any exercise program. You should be in good physical condition and be able to participate in the exercise.

The Company’s coaches are not licensed medical care providers. The Company further represents that it has no expertise in diagnosing, examining, or treating medical conditions of any kind.

The information contained in the Company’s blog, e-mails, programs, services and/or products is for educational and informational purposes only and is made available to you as self-help tools for your own use. While the Company’s coaches draw on prior professional expertise and background in many areas, you acknowledge that they are supporting you in their roles exclusively as Health Coaches.

Each individual’s health, fitness, and nutrition success depends on his or her background, dedication, desire, and motivation. As with any health-related program or service, your results may vary, and will be based on many variables, including but not limited to, your individual capacity, life experience, unique health and genetic profile, starting point, expertise, and level of commitment.

If this disclaimer scared you or dissuaded you from taking action, then our information, products and services are not for you. However, if this disclaimer inspired you to step up to the plate and make an honest effort working with us and the solutions we offer – congratulations! We look forward to working with you!

By using the blog, e-mails, or any of the Company’s programs or services, you implicitly signify your agreement to all parts of the above disclaimer.

I have read, understood, and hereby acknowledge this disclaimer in its entirety.

Signature(Required)

Personal Details

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Gender(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Address

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Select Coaching Plan(Required)

If applicable, please enter your referral code.

Occupation Information

Andres supports high performers aiming to eliminate their brain fog and get in the best shape of their lives, both for their own growth and for those they care about. Please select the option that best describes you:(Required)

Executive

Entrepreneur/Founder

Professional Athlete

Ambitious Professional (doctor, lawyer, accountant, etc.)

Software Developer/Engineer/Programmer

Other

Please mention

Please describe daily responsibilities according to occupation. The better we understand your workflow, the better we can design a program that will optimize your performance within and beyond work schedules. *Example answers: back-to-back meetings on Zoom, mostly in person meetings, sitting for hours on end, have to be extremely focused and attentive to detail, mostly leading teams/employees, giving lectures and presentations, etc

(Optional)

Your Schedule

Working Days Per Week(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Highly varied/contingent on the week

Other

Please write here

Average Daily Hours Spent Working(Required)

1-2hrs

3-5hrs

6-8hrs

9-11hrs

12+

other

Please mention

Are colleagues and/or employees frequently frustrated with you?(Required)

Yes

Why may this be the case?

Are you looking to improve your performance at work or with your team?(Required)

Communication

Time management

Empathy

Organization

Focus and staying on task

Managing stress

Eliciting flow states

Other

Please mention

Metrics

Please have a scale and tape measure ready. It is VERY important that we have these metrics.

Height (feet and inches)(Required)

Weight (pounds)(Required)

Please enter a number from 10 to 999.

What measuring tools do you have at your disposal? For weight scales, please specify brand make and model. For tape measure, specify unit of measurement. If entirely unfamiliar, please leave blank.

Metrics

To help us make the best health decisions for you, please provide as much information as possible by answering the following questions. Your responses are optional

Waist Circumference * Measure between the space just below your rib and above your hip bone, usually just above your belly button.

Hip Circumference * Measure the distance around the largest part of your hips, the widest part of your buttocks.

Body Fat Percentage (if available, leave blank or skip otherwise)

Past Medical History

Have you ever been hospitalized?(Required)

Yes

Why? For how long?

Do you have an existing medical condition?(Required)

Yes

Which one(s)?

Are you taking any medication/supplements?(Required)

Yes

Which one(s)?

Do you suffer from allergies?(Required)

Yes

Which one(s)?

Have you ever undergone surgery?(Required)

Yes

Which, and for what reason?

Do you suffer from any disability?(Required)

Yes

Which one(s)?

What are some wellness therapies you've previously or are currently partaking in?

Acupuncture

Massage therapy

Physical therapy

Cryotherapy

Sauna

Cosmetics

Enema

Cleanses

Detoxes

Other

Other wellness therapies

Social History/Habits

Do you meditate or do yoga?(Required)

Yes

Sometimes

Which of the following describe your sleep?(Required)

Consistent (number of hours)

Inconsistent (number of hours)

Trouble falling asleep

Trouble getting out of bed

Trouble staying asleep

Often waking up tired

Often waking up rested

Do you drink coffee/use caffeine?(Required)

Yes

Please describe source, quantity, time of day, and frequency of use.

Do you smoke?(Required)

Yes

Please describe source, quantity, and frequency of use.

Have you ever smoked?(Required)

Yes

How long ago did you smoke?

What variety did you smoke?

How many units did you smoke per day?

Do you drink alcohol?(Required)

Yes

Please describe source, quantity, and frequency of use.

Do you use recreational drugs?(Required)

Yes

Please specify type and frequency.

Social History/Habits

On a scale from 0 to 10 rate your general level of happiness.(Required)

0	1	2	3	4	5	6	7	8	9	10

(0 meaning none)

On a scale from 0 to 10 (0 meaning none) rate your general level of stress.(Required)

0	1	2	3	4	5	6	7	8	9	10

(0 meaning none)

On a scale from 0 to 10 (0 meaning none) rate your general level of anxiety.(Required)

0	1	2	3	4	5	6	7	8	9	10

(0 meaning none)

On average, how many hours do you spend in bed each night?

(Optional)

Please enter a number from 0 to 24.

Goals

Tell us what you want and expect to accomplish with this program.(Required)

I want to

Improve my physique and look great

Reduce brain fog and improve mental clarity

Promote longevity and prevent disease

Alleviate anxiety and strengthen stress resilience

Improve self esteem and confidence

Improve quality of sleep and recovery

Increase focus and productivity

Cultivate discipline and self-control

Enhance libido and sexual well-being

Other

Please describe

What wellness therapies would you like to include in your daily or weekly routine as part of your lifestyle? Please share why these interest you.

If you’re unsure or prefer us to decide, feel free to leave this blank

In 3 sentences or less, what does being healthy mean to you?

(Optional)

In 1-3 sentences, please tell us what you want to gain from this program.

(Optional)

Is there an initial deadline for these goals?

(Optional)

Nutritional Information

Have you done ANY food sensitivity, gut microbiome, or genetic testing in the past?(Required)

Yes

Please specify

Do you have, or have you ever had an eating disorder?(Required)

Yes

Please describe

Do you have any dietary restrictions due to religious beliefs, personal, beliefs, culture, or otherwise?(Required)

Yes

Please describe

Are there any foods you can’t live without?(Required)

Yes

Please describe

Do your eating habits change in stressful or emotional times?(Required)

Yes

Please specify (increase, decrease, additional comments)

How often do you eat “on-the-go”? i.e. during work, while standing, while driving, etc…(Required)

Always	Often	Sometimes	Rarely	Never

Nutritional Information

Can you provide an estimate of your daily caloric intake?

(Optional)

When do you typically eat? Please take your time to discuss your eating habits in detail, and try your best to specify frequency, time of day, inconsistencies if they are present, etc.

(Optional)

What kind of instruction do you typically provide to private chefs? What kind of information, preferences, and detail do you share with them? Are macro and micronutrients of consideration according to your health and fitness goals? Please specify.

(Optional)

Physical Activity

What would you consider your fitness experience level?(Required)

Beginner	Intermediate	Advanced	Athlete

How active are you?(Required)

I sit around all day	I walk around here and there	I exercise once in a while	I exercise regularly	I am very active	I’m an athlete

Does your current job require physical activity?(Required)

Yes

Does your current job require you to sit at a desk?(Required)

Yes

Do you have any previous physical injuries?(Required)

Yes

Maybe

Please describe

Please provide a list of current sports/physical activities as well as those you may be interested in partaking in.

(Optional)

Your current VO2max

(if available, leave blank or skip otherwise)

Tell us more

Is there anything that hasn't been covered that you would like us to know? Are there any other personal details you felt should be included?

How do you feel about embarking on this journey with us? We’re pumped! Thank you for taking the time to fill out all the details!

Are you ready?

Our program is designed to transform your life by introducing manageable changes to your daily routine, but it requires focus and discipline. Are you ready to commit to being the clearest, most present version of yourself throughout this journey?(Required)

Type “I will” to confirm

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Credit Card

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Onboarding

Personal Details

Address

Occupation Information

Your Schedule

Metrics

Metrics

Past Medical History

Social History/Habits

Social History/Habits

Goals

Nutritional Information

Nutritional Information

Physical Activity

Tell us more

Are you ready?

Credit Card

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fix your performance:
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