Name

Email Address

Age

Height (cm)

Weight (kg)

Gender GenderFemaleMaleOther

What coaching package have you purchased? What coaching package have you purchased? ALL-INCLUSIVE COACHING NUTRITION COACHING

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

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 Develop or Get control of eating habits / Lifestyle change Improve physical fitness Get stronger Look better Feel better Have more energy and vitality Physique competition / modeling Improve athletic performance Other

How often can you go to a gym? How often can you go to a gym? 2 days a week 3 days a week 4 days a week I can go to a gym even 5 days a week, if that's what is needed to achieve my goal. I don't / can't have access to a gym. I want to train at home.

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

Approximately how many hours per week? Approximately how many hours per week? Fewer than 5 hours 5-9 10-14 15-19 20 or more

Approximately how many hours a week do you do other types of physical activity? (e.g., housework, walking to work or school, home repairs, moving around at work, gardening) Approximately how many hours a week do you do other types of physical activity? (e.g., housework, walking to work or school, home repairs, moving around at work, gardening) Fewer than 5 hours 5-9 10-14 15-19 20 or more

Do you have experience with calculating macronutrients or food tracking in general? Do you have experience with calculating macronutrients or food tracking in general? 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