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Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What size shirt do you wear?

Height

Which nutrition coach did you want to work with?

Weight

Sex

Age

What do you do for a living?

How active is your job?

Do you smoke or drink alcohol? If so, how much and how often? (Please try to be specific)

Are you currently pregnant or breastfeeding? If so, how far along are you? (Women Only)

Coaching History

Training History

Do you currently use any fitness/wellness tracking tools? If so, what are they?

Do you have access to a well equipped gym?

How many days a week are you training?

structure? daily are

What is your current training structure? (i.e. Push/Pull/Legs)

How much cardio are you performing weekly?

About how much water do you drink daily?

Do you have a food scale?

Have you ever tracked your macros before? If yes, please explain your history and comfortability with it.

If currently tracking macros, what is your daily intake? How long have you been following these macros?

What does a typical day’s diet look like? (Include specific foods, meals, portions, brands, restaurants, etc)

Do you ever experience food insecurity? (inability to get food/groceries)

If you're taking any medications, please list them below (include dose, whether they're prescribed, and why you're taking them)

If you're taking any supplements, please list them below (include dose and why you're taking them)

What are your short term and long term goals?