Go back Please enable JavaScript in your browser to complete this form.E-mail *EmailConfirm EmailName *Age *Height & Current Body Weight * *How many years how you tried to diet for weight loss? *One YearTwo YearsThree or more yearsOn a scale 1 to 5 how would you rate your nutritional choices this past week? Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5Are you interested in: *TRACKING MACROS & CALORIES ONLYMEAL PLAN + RECIPES.HYBRID PLAN (MACROS + MEAL PLAN + RECIPES)WHAT ARE YOUR BIGGEST STRUGGLES WITH NUTRITION? i.e (I don't know what to eat or what are my maintenance calories) * STEPS PER DAY (AVERAGE): *HOW OFTEN DO YOU DRINK ALCOHOL? *EVERY WEEKENDEVERY OTHER MONTHONLY FOR SPECIAL OCCASIONS SUCH AS BIRTHDAYS, CHRISTMAS, ETC.I DON'T DRINKHAVE YOU EVER HAVE A NUTRITION COACH? IF YES, WHAT YOU LIKED AND WHAT DID YOU DISLIKE ABOUT IT? (YOU DON'T HAVE TO MENTION NAMES) *HOW OFTEN DO YOU EAT OUT? *1 - 2 TIMES PER WEEKEVERYDAYONCE A MONTHONLY FOR SPECIAL OCCASIONSWHAT IS YOUR LONG-TERM GOAL WITH YOUR NUTRITION? the more details, the better; as your future coach, I want to make sure I can help you as much as possible. *IT'S THIS YOUR FIRST TIME TRACKING MACROS?YesNoHOW REGULAR ARE YOUR PERIODS?RegularNo regularI don't get periods anymoreDO YOU TAKE ANY TYPE OF SUPPLEMENT? if yes, please list them *DO YOU TAKE STEROIDS? remember this info it's only between you and me.YesNoI used toDO YOU HAVE HEALTH ISSUES? If yes, please explain in detail. *IF YOU ANSWERED "YES" WHEN WAS THE LAST TIME YOU WENT TO THE DOCTOR OR GOT YOUR BLOOD TESTED?DO YOU WORK OUT?YesNoIF YES, HOW MANY DAYS PER WEEK DO YOU WORK OUT, WHAT TYPE OF EXERCISES DO YOU DO, AND FOR HOW LONG? (i.e Powerlifting, 4x per week x 2hrs) *ARE YOU VEGAN?YesNoWHAT DO YOU DO FOR A LIVING? (Teacher, nurse, student) *PLEASE SELECT YOUR ACTIVITY LEVELS: *1.2 Desk job & no exercise (sedentary)1.3 Desk job but exercise sometimes or you have a active job such as nurse (Light Active)1.55 You have a sedentary job but workout at 5 days per week OR You don't workout but your job its very active such as construction (Moderate Active)1.7 You exercise regularly, and you have a physically demanding job where you are on your feet a lot and picking up stuff (active)1.9 you workout every day + you have a high demanding job with little breaks (very active)DO YOU KNOW HOW TO COOK?YesNoHAVE YOU EVER BEEN DIAGNOSED WITH AN EATING DISORDER? (This is completely private but its important for me as your coach to know this things) *YesNoNot diagnose but I think I have an ED.IF YES, WHAT TYPE OF ED, AND ARE YOU ON TREATMENT FOR IT?IF YOU ARE CURRENTLY TRACKING OR YOU WERE, DO YOU KNOW YOUR CALORIES INTAKE?PLEASE DESCRIBE YOUR ENVIRONMENT AT HOME. (I.e: I am single, I cook my own meals, or I am a husband I cook for my family, but I don't do the groceries shopping, My family does not support my dieting, etc.)ARE YOU WILLING TO FOLLOW MY PROGRAM AND RESPECT MY TIME AS YOUR COACH?YesNoDO YOU UNDERSTAND THAT ONCE I HAVE SENT YOUR PROGRAM, I CANNOT REFUND YOUR MONEY?Yes, I understand.HOW WOULD YOU LIKE TO COMMUNICATE?DO YOU UNDERSTAND THAT ONCE I HAVE SENT YOUR PROGRAM, I CANNOT REFUND YOUR MONEY? (copy)PHONE CALLEMAILTEXT MESSAGESIF YOU PICKED PHONE CALL OR TEXT PLEASE LEAVE ME YOUR PHONE NUMBEROPTIONAL - What's your Instagram or Facebook username?Apply Go back
