Macro Assessment Application

This application is for interest in my 12 week 1:1 Functional Nutrition Coaching Program. In this Program I will teach you how to properly fuel your body to feel your best and fit your lifestyle. This form is very detailed because I am invested in your success as you must be too. Change isn't easy, so if you are serious about physically, emotionally, and financially investing in yourself, please complete this form so we can connect and discover if we are a good fit for each other.

Thank you for your interest! I will be in touch within the next 24 hours to schedule a consult call.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Current Goals

Age:

Height

Current Weight

Instagram handle (optional)

Average Daily Step Count (if known)

How many times a week do you exercise?

Tell me about your workouts. How many times a week of cardio? Weight Training? How long are sessions and what kind of workouts specifically?

An example of a typical and realistic weekday of eating for you

An example of a typical and realistic weekend of eating for you

Have you ever tracked Macros before?

Education Level of Nutrition

Tell me about your dieting history in general, including types of diets, how many times in the last 5 years, and for how long for each diet?

Dietary preferences such as gluten free, plant based, pescatarian?

Weekly Alcohol Intake

Average hours of sleep each night

Do you have any health issues, injuries, medical conditions? Pregnant or Breastfeeding?

Current supplementation if applicable (ex; magnesium, creatine, etc.)

What does your daily schedule look like? (work, school, gym, etc)

What do you see as your biggest hurdles and challenges in reaching your nutrition goals?

Anything else I should know to best help you? What do you want to achieve together that you have not been able to achieve alone?

I am ready to invest in myself, and willing to be coachable in order to learn sustainable ways that will allow me to feel my best and show up for myself in a way that makes me proud

New Client 1:1 Coaching Application