Janvier- Nutrition & Training Intake Form

Coach Janvier & Ramone | Maximize Your Potential | www.gainsart.com
Nutrition & Training Intake Form

Please provide lots of details. *Strictly confidential.
Name

First NameLast Name
Email
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Age/Gender/Weight/Height
What are your fitness goals?
What is your WHY? Core reasons you want to embark on this journey
What is your current exercise routine, duration, and frequency ?
Where do you train? And what time?
What is your occupation & schedule? List out your day by hours
Are you currently participating in any sports? If you do, which sports and how often?
Do you have any medical conditions or injuries? Muscle or joint pain?
When was the last time you were on a diet or training program?
Please list out your current diet, what you usually eat throughout the day, how many meals you eat? Please be detailed.
Do you have any food allergies, sensitivities, or dislikes?
List your favorite whole foods and favorite cheat meals
List any supplements or vitamins you are currently taking
Are you taking any medications? If so, please list the medications
Do you smoke? Do you drink alcohol? How often?
Do you drink caffeinated drinks? If yes, how much per day?
How would you rate your overall life stress

1

2

3

4

5

6

7

8

9

10

1 is Low, 10 is High
What possible barriers do you feel are preventing you from reaching your health and fitness goals?

Other
Why do you need a coach?

Other
Plans

Full Monthly Online Coaching - $250

Includes:

*3 or 6 months plan

*20% off on 6 months plan

*Option to renew or continue on a month to month basis

I would like the:
*GST is included
Current Physique
Please Upload 3 FULL BODY PICTURES OF YOUR CURRENT PHYSIQUE In Shorts or Underwear Showing Your FRONT, BACK & SIDE While Standing Straight With Arms Down and Relaxed.

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Nutrition & Training Intake Form