Nutrition Program
The better you describe yourself, the better I can personalise your NUTRITION program. Make sure you fill in the food section in detail and don't forget anything.
Name
*
First Name
Last Name
E-mail
*
Make sure your E-mail is correct. In case of incorrect email address it will not be possible to contact you.
Nationality
Where are you originally from? Your nationality will tell me what foods are typical for you.
Phone Number
*
-
Area Code
Phone Number
Metric units
*
Height in cm
Weight in kg
Age
What is your goal and what do you want to look like?
*
What is the most important goal for you?
*
Increase health
Be stronger
Physique improvements
Bikini competition
What is your motivation to achieve this goal?
*
In what time do you want to achieve this goal? And what are you willing to do to achieve this goal?
*
MOVEMENT
Please describe me your movement activities.
Please describe your job and daily routine.
*
Please describe your training/ physical activity over the 3 past months.
*
What is your normal daily activity?
*
Sedentary: Spend most of the day sitting (e.g. administrator, doctor)
Lightly active: Spend a good part of the day on your feet (e.g. teacher, salesperson)
Moderately active: Spend large part of the day doing physical (waitress, gardener)
Very active: Spend most of your time doing hard physical work (e.g. carpenter, top athlete)
NUTRITION
Please describe to me what did you eat for the last three days and how looks like your nutrition at the weekend day?
What did you eat today?
*
Breakfast: Snack: Lunch: Snack: Dinner: Drinks: Something extra:
How big are your portions of food? How much oil do you use? How much alcohol, coffee or other drinks you drink? Be specific and truthful.
What did you eat yesterday?
*
Breakfast: Snack: Lunch: Snack: Dinner: Drinks: Something extra:
How big are your portions of food? How much oil do you use? How much alcohol, coffee or other drinks you drink? Be specific and truthful.
What did you eat two days ago?
*
Breakfast: Snack: Lunch: Snack: Dinner: Drinks: Something extra:
How big are your portions of food? How much oil do you use? How much alcohol, coffee or other drinks you drink? Be specific and truthful.
What did you eat at the weekend day?
*
Breakfast: Snack: Lunch: Snack: Dinner: Drinks: Something extra:
Do you change your routine over the weekend? Do you drink more alcohol or do you go to dinner?
What supplements do you use?
*
Vitamins, minerals, protein, pre-workout, daily greens, collagen, omega 3, creatine?
Do you suffer from any allergy, intolerance or don't eat some kind of food?
*
Are you diabetic? Do you have lactose or gluten intolerance? Are you a vegetarian? Which food you don't eat?
What kind of food do you like?
*
Are there the foods you eat often and love them? What are your taste preferences?
Have you overcome any diets over the 6 past months? Which ones?
*
How many portions of food can you eat per day?
*
3-4
4-5
5-6
How often and how much alcohol do you drink?
*
HEALTH
Please describe your medical condition.
Do you have good, deep and enough long sleep?
*
Do you have any health problems and using medicaments? Which one?
*
What is your menstrual cycle and period?
Do you suffer from irregular menstrual cycles, PMS symptoms, menstrual difficulties?
Do you use any kind of hormonal contraception?
Do you smoke?
*
Yes
No
Occasionally
What is your stress level in range from 1-10?
*
1 is low 10 is very high
Upload your photos in swimsuit or underwear from front, back, right and left side:
*
Browse Files
Drag and drop files here
Choose a file
Photos must be taken in a good light or daylight with a one colour background, in swimsuit or underwear and from the level of the middle of the body of photographer. Dark photos and photos from ground level or head level will not be accepted and will be asked to take pictures again.
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of
Do you agree to the use of your BEFORE and AFTER photos to promote WholeLifeFit's work on social networks, websites and promotional materials? By agreeing to the publication of your photos, you will help the business grow. Thank you!
Yes, I agree.
Yes I agree, without posting my face.
No, I don't agree.
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Nutrition Program
Personalised nutrition coaching monthly subscription.
$
159.00
NZD
for each
month
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