Name *

Main Phone *

Main Email *

Date of birth *

What is your height and body weight? *

If you have a desired body weight, please share it below. Otherwise, please write "N/A". *

What is your number 1 goal? It can be to feel performance in the gym, leaning out, losing larger amounts of weight, improving overall health— Just choose one for now, but let me know what your overall goals/ambitions are! Leaning out because that in turn helps my gym performance and overall well being *

How important is the goal written above to you on a scale of 1-10? 1 being LEAST important; 10 being MOST important. *

What are some things that you have tried in the past to reach your fitness/nutrition goals? Please explain what you liked about them and what you did not like. *

Are you currently tracking your daily macros and/or calories? If YES, please indicate the numbers. *

Do you like to cook?—do you find yourself dining out a lot? Have you ever tried meal prepping? *

What does your current weekly exercise routine look like? Please go into detail about your weekly routine as well as what your workouts entail. *

What time of day do you workout? If your workout time varies and indicate all the times in which you currently workout weekly (e.g., afternoons AND evenings). *

Do you drink alcohol? If yes, about how many drinks per week? *

What do you do for work? Do you work a set schedule or rotating schedule? *

Describe a typical day of eating — Include meals from what a "normal" day would look like, not when you’re trying to be healthy (unless that’s normal for you). *

Do you understand the feeling of hunger? Describe what this means to you. *

Are you typically hungry around meal times, or do you have to make an effort to eat? *

When are you hungriest throughout the day? *

How much time is there in between eating your meals? Please list variabilities, including on work days and weekends. *

Do you eat until you are stuffed or until you are satisfied? *

If you chose "It depends" for your answer above, please elaborate here.

Does it take you less than 10 minutes to eat a meal? *

How many hours do you sleep per night on average? *

What time do you go to bed on a typical evening? *

What time do you wake up on a typical morning? *

Do you typically sleep through the night, or wake up? If you wake up, how many times? *

Are you taking any supplements, vitamins and/or adaptogens? If yes, what are you taking and what time of day do you take them? If not, are you open to suggestions? *

Are you currently on any medications? If YES, please list your medications and dosages. *

Are there any medical related issues affecting you on a regular basis that you are not may not be seeking medical attention for at this time? Ex: Anxiety, stress *

When was your last physical with blood work? Did your doctor make any dietary/fitness recommendations based on your blood work? *

Do you have any food allergies/sensitivities? Have you been prescribed a diet from a medical professional? If so, please provide this information. *

Are you under the care of any other medical professional (i.e., Psychiatrist, Psychologist)? If yes, which medical professionals do you see? *

What other major stressors are in your life? *

What usually prevents you from reaching your goals? List at least 3 things that come to mind. *

Take a moment to think about your "why?" It may be to lose weight, or move better, but often it is much deeper than that. Jot down a few of your "whys" of taking the next step and working on your nutrition with a coach. *

Do you have a supportive spouse/roommate and supportive family? *

List 3 things that you expect/need from your coach. *

Please indicate your gender below. *

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