Nutrition/fitness consulting intake form
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Full Name *
Gender *
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Age *
Height *
Current Weight *
Goal Weight *
Overall Goal?
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How would your rate your overall daily activity level? *
Rate your experience with working out. *
Beginner
Advanced
How many days will you commit to exercising? *
Job Description *
How much time can you dedicate to each workout session? *
Home workouts or gym workouts? *
What foods do you dislike or are allergic to? *
What foods do you really enjoy? *
What does your current diet look like? (Be sure to include any drinks such as juice, soda, etc.) *
Are you able to pack your meals and eat them at work? *
Are you familiar with tracking macros using an app such as MyFitnessPal? *
Do you have any dietary restrictions? (If Yes, please list below)
Are you currently taking any medications or supplements. (If yes, please list in detail below)
Are you open to trying plant-based proteins and new foods? *
How many hours of sleep do you average per night?
Do you have any injuries or chronic medical conditions (diabetes, heart conditions, etc.) that I should consider while putting your plan together? *
What is the biggest issue you feel has held you back from achieving your goals? *
Do you have any additional questions or concerns about me, my experience or coaching style?
Instagram Name
Email Address
Phone Number
Best way to contact you? *
Best time of day to contact you? *
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