1:1 Coaching with Jordan Wise Intake Form
Name
First Name
Last Name
What are your physique goals? Lose weight? Lean out? Gain muscle? Maintain current body composition? Compete one day? Describe in your own words. The more detail you can provide, the better.
Mental goals as they relate to your relationship with food:
Any issues with eating you currently struggle with or have struggled with in the past?
Current Weight
Height
Age
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current Water Intake
What does your current diet look like? The more specific you can be, the better. If you have a current meal plan, upload it using the spot below. If not, try and send me a "sample day" of what you might eat on a regular day. If you know your current calorie or macro intake, please include that, as well.
Current Meal Plan (if applicable)
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Current Cardio (mins and sessions per week)
Current Training Plan/Split (if you have this in a PDF or word doc, you can skip this box and upload it below)
Current Training Plan (if applicable)
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Please list any supplements, medications, or gear you are currently taking AS WELL AS any side effects:
Are you opposed to taking PEDs?
List any injuries you have or have had in the past:
Latest Bloodwork Report
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If you have images of physiques you like (goal physique), feel free to upload them here:
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Clean foods that you love and foods that you hate:
Food allergies:
Anything else you'd like me to know or discuss:
Submit
Should be Empty: