Name

Email Address

Age

Height (cm)

Weight (kg)

Body Fat % (if you know it)

Gender GenderFemaleMaleOther

What are your goals? Check all that apply. What are your goals? Check all that apply. Lose weight / fat Add muscle / Gain weight Maintain weight Postpartum recovery Develop or Get control of healthy habits / Lifestyle change Improve physical fitness Get stronger Look better Feel better Have more energy and vitality Physique competition / modeling Improve athletic performance Other

Are you regularly active in sports and / or exercise? Are you regularly active in sports and / or exercise? Yes No

This is a relationship that we are creating together. I will create this plan around you. However, all I can do is create a plan for you, I cannot execute it. That is totally up to you! I will be there for you 100% along the way, but you are the one to achieve your goals. Right now, on a scale of 1-5, how ready, willing and able are you to change? This is a relationship that we are creating together. I will create this plan around you. However, all I can do is create a plan for you, I cannot execute it. That is totally up to you! I will be there for you 100% along the way, but you are the one to achieve your goals. Right now, on a scale of 1-5, how ready, willing and able are you to change? 1 - Not at all 2 3 4 5 - Completely