Coaching Program Questionnaire
100% Confidential – Please Answer Honestly

Contact Info

First Name:
Last Name:
Email Address:
Home Phone:
Mobile Phone:
Skype Id:

Personal History

  1. Please list any/all diets you’ve previously tried and any results (if any) or comments.

  2. Please list any/all medications you’ve taken in the past for an extended period of time and any/all medications you are taking now.

  3. Are you suffering from any illnesses, diseases or major health challenges?

  4. When did your weight problem begin (please be as specific as possible, even if it was a very long time ago).

  5. How much weight do you need to lose?

  6. Are you currently dieting (meaning restricting intake, counting calories, exercising according to a calorie deficit plan, etc.)?

  7. Have you read, The Gabriel Method? If so, have you made any changes since?

The Gabriel Method PTY LTD. ACN: 134 280 381. Shop 8, Palm Court, Strickland Street, Denmark, WA, 6333, Australia.
Ph: (08) 9467 2643 (Australia) or (310) 982-6594 (USA)


Health Disclaimer: The Gabriel Method is not intended to treat, cure, or prevent any disease or illness. This information is intended for educational purposes only, not as medical advice. Always check with your doctor before changing your diet, eating, or health program.