Nutrition Only Coaching Sign Up Form
Thank you for deciding to take the next step in reaching your health & fitness goals. This is a comprehensive food & training questionaire so I can gather the relevant personal information so I can provide you with the optimal nutrition plan to suit you, your lifestyle & your goals.
Basic Information
Please answer all the questions in detail and honestly.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Age:
Height:
Weight:
D.O.B:
Goal: In detail what is your current goal? (Body & fitness related) Do you have a specific timeline for this goal?
Food & Drinks:
Please provide a meal diary of what you would normally eat on a daily basis, include any drinks or snacks.
What are your favourite foods?
What foods do you not like/eat?
Do you have a preference of how many meals/snacks you would like per day?
Are you intolerant to any foods?
Do you have a preference of how many meals/snacks you would like per day?
What is your current relationship with food?
How many litres of water do you consume each day?
Do you consume any other liquids on a daily basis? Eg: coffee, fruit juice ect
As well as any other information that may or may not be relevant
Training:
Are you currently training?
Yes
No
If yes, please go into detail with type of training (weights, cardio ect), length of sessions (eg. 45 mins), intensity of sessions & how many times per week
As well as any other information that may or may not be relevant
Lifestyle
What do you do for a living?
How active are you at work?
Low (seated, desk work)
Moderate (light walking, retail)
High (physical worker/tradie)
Does your job involve shift work or what is your normal working day?
How many hours of sleep do you get each night?
What are your stress levels like? (work & home life)
How much alcohol do you consume a week?
Are you currently taking any supplements/medication?
As well as any other information that may or may not be relevant.
How do you feel during the day? (tired, energized, exhausted)
Waiver
Signature
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