Name
*
First Name
Last Name
Email
*
Mobile Number
*
Date of Birth
*
MM
DD
YYYY
Please choose one of the below methods for me to calculate your body fat %:
*
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
*
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 diet and training?
*
What is your main obstacle to achieving your goal?
*
Please pick one option below. Both nutrition plan options are accessed in the app and adjusted at each check-in.
*
What do you think needs to be improved most with your current nutrition & Why?:
*
Do you have any health/medical conditions? If yes please list them and detail how these may impact your training or goals
*
Are you taking any medications? If yes please list them below
*
Please list any special dietary requirements you have including any intolerances. or allergies
*
Please list any foods you don’t want on your diet.
*
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?
*
Please list any foods you DO want on your diet, and email me photos of nutrition panels or list exact brand and product names
*
Please list the foods and drinks you would typically consume in one day, including supplements, and water intake
*
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?
*
Would you be willing to give up drinking alcohol, or cut back significantly, to achieve your goals?
*
Are you mostly sedentary, moderately active, or very physically active in your job?
*
Are you currently exercising? If yes, please outline a typical week of exercise.
*
Do you have any weights training experience, in particular with deadlifts, squats, leg press, bench press, seated military press? Please elaborate.
*
What muscle groups, or exercises do you want/need to focus on?
*
Have you ever had a personal trainer or online coach?
*
Please list all past and current injuries if any.
*
Will you be training at a gym or at home?
*
Minimum requirements for training at home: barbell, squat rack, plates, dumbbells, flat bench.
How many times per week can you train?
*
Do you have a preference for what days of the week you train on?
*
How did you find out about me?
*
Referral
Google
Facebook
Instagram
Advert on Social Media
