Janvier- Nutrition, Training Intake Form

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

Please provide as much details you can. *Strictly confidential.
Name *

First NameLast Name
Email*
Phone Number*
Please enter a valid phone number.
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?*

TimeConsistencyLack of ResultsLack of motivationNot knowing what to do toAccess to gym/equipmentMoneyOther
Why do you need a coach?*

I need someone to keep me accountable to my health and fitness goalsI need a motivator who can push me to reach my health and fitness goalsI'm stuck, I'm not getting the results I want and I need help getting to the next levelI need someone who can help me develop life long health and fitness habitsI need someone who can help me figure out the nutrition and workout plans that work best for meOther
Plans
Please indicate which plan you are applying for.*

One Time Customized Nutrition Plan- $125One Time Customized Training Plan- $125One Time Customized Training Plan & Nutrition Plan- $200Full Monthly Online Fitness Coaching, 3 months Plan- $750Full Monthly Online Fitness Coaching, 6 months Plan- $1200, 20% off applied, Save $300
*Option to renew plan or continue on a month to month basis at regular price of $250

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

Cancelof
Should be Empty:

Coach Janvier & Ramone | Maximize Your Potential | www.gainsart.com

Nutrition, Training Intake Form

Plans