Name
*
First Name
Last Name
Email
*
Goal
*
Activity level
*
Very light - Sitting most of the day (ie. desk job)
Light - Mix of sitting, standing (ie. teacher)
Moderate - Continuous gentle to moderate activity (ie. server)
Heavy - Strenuous activity throughout the day (ie. construction work)
Weekly workout activity
*
Very light (almost no purposeful exercise)
Light (1-3 hours of gentle to moderate exercise)
Moderate (3-4 hours of moderate exercise)
Intense (4-6 hours of moderate to strenuous exercise)
Very intense (7+ hours of strenuous exercise)
Anything else you'd like to share regarding your goals...
Do you have any medical conditions or injuries that may affect your ability to exercise?
What types of exercises do you enjoy the most?
Preferred eating style
*
Anything (No major preferences or restrictions)
Keto (Very high fat, low carb)
Vegetarian (Plant based, small amounts of eggs & dairy)
Vegan (Fully plant based)
Paleo (Emphases meats, veg & healthy fats)
Mediterranean (plant foods, healthy fats, moderate amounts of lean protein)
How many meals do you like to eat each day? *Including snacks
*
1
2
3
4
5
6
7
8
Do you have a preferred eating schedule?
Would you prefer a structured meal plan with specific meals and snacks outlined for each day, or do you prefer more flexibility and guidance on portion sizes and food choices?
*
Structured & Consistent
More meal choices the better
Are there any specific health concerns or conditions that you would like to address through your diet?
Please share anything you feel may be important for us to know!
How would you rate your current water intake?
*
Definitely could drink more water
I think I do ok
I drink plenty
What's your caffeine intake like?
*
I could do without it
I drink 1-2 caffeinated beverage a day
Probably too high
Are you currently taking any supplements?
If anything has been recommended by your doctor, please specify
Lifestyle and Schedule
What is your typical daily schedule like?
Are there any days of the week when your schedule is busier or more hectic?
Do you smoke or consume alcohol?
How would you describe your current stress levels?
Low
Moderate
High
How many hours of sleep do you typically get each night?
