Direct Macro Nutrition - Initial Evaluation Form

Initial Evaluation

Please answer the questions below relating to your health and fitness. Be as specific and truthful as possible to ensure you achieve the best results.
Program*
First name*
Last name*
Email*
Please use the same email you used to register for the program.
Pick your start date*

MonthDayYear
Pick your starting Monday at least 12 days from now in order to give us time to mail your welcome package to you.
Gender*

FemaleMale
Age*
Current weight in pounds*
Please round your current weight to the closest whole number
Body type*

EctomorphMesomorphEndomorph
In the past 4 months, have you lost, gained, or maintained your weight?*

Lost (if more than 5 lbs)Maintained (if within 5 lbs)Gained (if more than 5 lbs)
How many whole pounds have you gained or lost?*
Currently vegetarian or vegan*

NoYes
Currently breastfeeding*

NoYes
Currently training for a competitive event*

NoYes
How many hours of training for the event per week on average?*
Long-form Questions
Why did you join the program?*
What is the overall goal you want to achieve?*
When you reach the goal, how will life be different?*
What do you expect to be the biggest hurdle you will face during the program?*
Liability Waiver
As with any diet and exercise program, you should consult your primary care physician (PCP) before starting the program. The program is intended to supplement – not replace – medical care or advice as part of a healthy lifestyle. Therefore, the information you receive should be used in conjunction with the guidance and supervision of your PCP. We are not medical professionals, and the program is not designed to treat or cure any health conditions. By clicking submit, you agree that you are in good health and acknowledge that it is your responsibility to seek professional medical advice before starting the program.
Signature*

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Initial Evaluation

Long-form Questions

Liability Waiver