Welcome.

Welcome to SMV4K.com where redpilled, K-selected people meet to create the life they want.

New Coaching Client Questionnaire

Please fill out this form so that I have a basic understanding of you and your needs.

The more information you provide, the more effective I can make the coaching sessions.

I will review this information before our first session.

Name

First Name

Last Name

Age

Sex

Male

Female

Where do you live?

Time Zone

Occupation

How would you describe your occupation?

Income

How much do you expect to earn this year?

Diet

How would you describe your diet over the last two weeks?

Exercise

How much physical activity do you usually get in a normal week?

Fitness level

How would you describe your fitness level?

Sleep

How would you describe your normal sleep patterns over the last month?

Therapy

Have you ever been in therapy before? Are you in therapy now? If you stopped therapy, why did you stop?

Substance use

What would you like to tell me about your use of substances? (Including even coffee, tobacco and prescription drugs.)

What do you estimate your IQ to be?

Sexual history

What would you like to tell me about your sexual history? Have you ever lived with someone your were in a sexual relationship with?

Height

How tall are you?

Weight

How much do you weight?

Religion

Is there anything about your religious beliefs or history that you would like to share?

Family

How would you describe your family and childhood?

What do you expect?

What do you expect from the coaching process? With what do you want help?