BEFORE YOU BEGIN

Health Information Consent

KetoTrainer asks for health and lifestyle information so that it can apply program safety rules, determine your KetoTrainer classification and recommend an appropriate starting program and Journey.

I consent to KetoTrainer Pty Ltd collecting and using the personal and health information I provide to assess my eligibility, apply KetoTrainer’s program classifications and safety rules, personalise my program, deliver my program and complete future Progress Checks. I understand that KetoTrainer program classifications are proprietary program classifications and are not medical diagnoses. I confirm that the information I provide is accurate and complete to the best of my knowledge and that I will repeat the KetoTrainer safety check if my health, pregnancy status or medication changes. I have read the Privacy Policy and Terms & Conditions.

I agree to the Health Information Consent above.

Privacy Policy and Terms links must be added before production launch.

QUESTION 1 OF 12

Tell us where you are in your hormonal stage.

Age

Which best describes your periods right now? Regular Changing or irregular No natural period for 12 months or more I have had a hysterectomy and/or ovarian surgery Unsure

QUESTION 2 OF 12

Are you currently using hormone therapy or hormonal contraception?

Choose one HRT Hormonal contraceptive / pill Both Neither

QUESTION 3 OF 12

Have you been diagnosed with any of the following?

Select all that apply.

QUESTION 4 OF 12

Do any of these apply to you right now?

Select all that apply.

QUESTION 5 OF 12

Do you currently take any prescription medication?

Choose one No Yes Unsure

QUESTION 6 OF 12

Tell us your current measurements and your main goal.

Height (cm) Weight (kg)

Waist (cm) optional

Main goal Lose body fat / weight Improve eating habits and consistency Improve energy / wellbeing Maintain weight / improve body composition Other

QUESTION 7 OF 12

Over the past 2 weeks, how would you rate your sleep and recovery?

Choose one Very poor Poor Okay Good Very good

QUESTION 8 OF 12

Over the past 2 weeks, how would you describe your hunger, cravings and energy?

Hunger between meals Easy to manage Sometimes difficult Often difficult

Cravings Rare / easy to manage Sometimes difficult Frequent or hard to control

Energy through the day Mostly steady Sometimes low or variable Often low or unstable

QUESTION 9 OF 12

Tell us about your usual eating pattern.

Planned meals on most days 3 planned meals 2 planned meals 1 planned meal Varies widely from day to day

How often do you graze or snack between planned meals? Rarely / never Sometimes Most days / often

How often do your main meals include a clear protein source? Most main meals Some main meals Rarely

Have you repeatedly lost weight and regained it after previous diets or programs? No Once Several times

How often does alcohol make it harder to follow your intended eating plan? I do not drink / never Occasionally Most weeks / often

QUESTION 10 OF 12

How active are you in a typical week?

Walking / general movement Mostly seated with little purposeful activity Some walking/activity 1–2 days/week Regular walking/activity 3–4 days/week Active 5+ days/week

Resistance / weight training None 1 session/week 2 sessions/week 3 or more sessions/week

QUESTION 11 OF 12

Have you tried deliberate fasting before?

Choose one Never Comfortable around 12 hours Comfortable around 14 hours Comfortable around 16 hours or longer I tried fasting but felt unwell or could not tolerate it

QUESTION 12 OF 12

Which eating approach would you prefer if it is suitable for your KetoTrainer starting state?

Diet preference Keto Non-Keto I am open to KetoTrainer’s recommendation

Food requirements — select any

ASSESSMENT RESULT