Name
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First Name
Last Name
Email
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Date of Birth
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MM
DD
YYYY
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Please choose one of the below methods for me to calculate your body fat percentage:
1. Skin fold method. I need 7 measurements in mm:
chest, abdominal, thigh, tricep, subscapular, suprailiac, midaxillary
2. Dexa / InBody / Evolt / Tanita scan
3. Tape measure method: I need 3 measurements in cms:
neck (widest point) waist (around belly button), hips (around bum)
Describe the goals you want to achieve, and why it is important to you
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In detail describe any of the following: your body composition goal; strength goals; lifestyle goals; habit goals (e.g. to look and feel fit and strong, be more consistent with drinking enough water each day, prioritising meal prep, and getting strong in the gym)
What has/has not worked for you in the past regarding nutrition and training?
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What is your main obstacle to achieving your goal?
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What do you think needs to be improved most with your current nutrition & Why?:
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Do you have any health/medical conditions? If yes please list them and detail how these may impact your training or goals
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Are you taking any medications? If yes please list them below
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Please list any special dietary requirements you have including any intolerances or allergies
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Please list any foods you don’t want on your diet.
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Please list any foods you DO want on your diet, and email me photos of nutrition panels or list exact brand and product names
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Do you currently take protein powder? What is the brand and specific product? If you don't take anything, are you open to trying it?
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Please list the foods and drinks you would typically consume in one day, including supplements, and water intake
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If it varies, or you have good days and bad days, please give an example of a ‘bad day’. Please list as Meal 1, meal 2 meal 3… etc. Provide as much detail as possible
How much alcohol do you typically drink per week? (e.g. 4 standard drinks twice a week)
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Would you be willing to give up drinking alcohol, or cut back significantly, to achieve your goals?
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Would you describe your job as sedentary, moderately active, or very active?
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Are you currently exercising? If yes, please outline a typical week of exercise.
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How did you find me?
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Web search
Instagram
Facebook
Referral
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