Women’s Confidential Health History Women's Confidential Health History Health and lifestyle information to share with your coach in order to tailor a personalized health plan for you. Name First Last Email PhoneBest time to call youAgeDate of BirthPlace of BirthHeightCurrent WeightWeight 6 months agoWeight 1 year agoWhat do you want your weight to be?Are you in a relationship now?If you have kids, tell me about themHow about pets?Tell me about your jobWhat are your main health concerns?What other concerns or goals do you have?At what point in your life did you feel the best?How is the health of your mother?How is the health of your father?What about any siblings?Do you sleep well? How many hours? Do you wake up at night? If so, do you know why?How are your periods? Regular, infrequent, painful, etc.Reached or approaching menopause? How are you doing with that?Do you experience any urinary tract, yeast or other types of infections?What about stomach/GI problems such as constipation, diarrhea, gas, acid reflux etc?Do you have any allergies or sensitivities such as to grasses, pets, foods or anything else?Do you have any chronic pain, stiffness or swelling?Do you have now or have had in the past any other serious illnesses or injuries?Are you currently under the care of a doctor for any of the above? How about any alternative healers or therapists?Do you take any prescription medications? How about supplements like vitamins, herbs etc?Tell me about your activity level. Are you active in sports or other activities? Do you exercise, how much?What foods did you eat as a child? Breakfast, lunch, supper, snacks, drinks etcWhat's your diet like today? Breakfast, lunch, supper, snacks, drinks etc.Will your partner/family/friends be supportive of your desire to make food and lifestyle changes?Do you cook? Do you like to cook? What percentage of your food do you eat at home? Where do you get the rest from?Do you have cravings like sugar, coffee, cigarettes or have any major addictions?Are you happy with yourself and your life? Why or why not?What would you like to change about your diet or other lifestyle habits?Is there anything else you want to share that would help me to personalize a health plan for you?