Custom Macro Pack
PERSONALIZED MACROS FOR YOU
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
First Name
Last Name
Email
example@example.com
Height (FEET/NCHES)
Weight (LBS)
Age (years)
My main goals are focused around
Weightloss
Muscle gain
Strength gain
Athletic performance
Other
List your specific goals from 1-3 in importance
What do you eat and drink on a regular basis?
Do you have any food allergies or intolerances? If yes, list below.
What are some of your favorite foods and beverages?
Do you have any concerns with your current eating habits? If yes, explain below.
Do you have any barriers to healthy eating, or changing your eating behavior? If yes, explain below.
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Will you need further support? If yes, please fill out the Nutrition Coaching Questionnaire.
BY SIGNING BELOW;I AM AWARE THAT I AM PURCHASING AND RECEIVING A CUSTOMIZED MACRO PACK AND RELEASE JILLIAN KLYM FROM ANY FURTHER RESPONSIBILITY TIED TO COACHING AND I ACKNOWLEDGE THIS IS A ONE TIME PURCHASE.
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