Name
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First Name
Last Name
Email
*
Phone
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Age
Height
Weight
What does your current nutrition look like? If you know your calories/macros please provide them.
Are you gaining, maintaining, or losing weight on your current intake?
On a scale of 1-5, how is your relationship with food? 1 being anxious, guilt after eating certain foods, feeling the urge to binge, or wanting to restrict. 5 being intuitive and regulated. Add any notes if necessary.
Have you ever tracked your food intake? If not, is this something you’d be willing to do?
Do you have a history of chronic, restrictive, or yo-yo dieting? This may seem private, but this is important metabolic information or me to know.
When was the last time you dieted to lose fat/weight? How long did you diet for?
Do you prefer carbs or fats more? Or both equally?
How would you rate your overall digestion? Please note any current or past issues.
Are you currently taking any supplements?
Do you peform cardio? If so, how many times per week and for how long?
Do you currently workout? If so, how many times per week and what do you participate in? E.g. strength training, HIIT classes, Crossfit, etc.
Have you had any current or past injuries that inhibit your workouts? Please give the location of the injury and what exercises/movements you cannot perform.
What does your daily activity outside the gym look like? E.g. highly active, sedentary desk job, etc.
How would you rate your overall sleep? How many hours a night do you typically sleep?
How would you rate the stress in your life? Low, moderate, high?
If any, has there been obstacles that have kept you from achieving past goals? E.g. not consistent, tried a diet that didn't work, lack of accountability, an all or nothing mindset, etc.
What are your long term goals?
What are your short term goals?
Which service are you interested in?
In-person Training
Online Training
What is the best way to contact you?
Phone
Email
