Nutrition Plan Application
Where your personalized nutrition plan starts...
By completing and submitting this form you are agreeing to receive email communications, including a Personalized Nutrition Plan from Coach Chrystal. Your personalized nutrition plan will be emailed to you at the email address you provided above within 2 working days of receipt of payment.
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I agree
Name
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First Name
Last Name
Email
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example@example.com
Age (in years)
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Height (in inches)
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Weight (in pounds)
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Body fat % (if known)
Biological Sex
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Male
Female
Intersex
Preferred Pronouns
Which of the below best describes your goal?
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Lose Weight (lose at least 5kg/10lbs)
Improve Health (improve nutrition while maintaining current weight)
Body Composition (lose less than 5kg/10lbs while building muscle)
Build Muscle (build muscle and increase overall body weight)
Athletic Performance (support long and intense athletic training)
What is your goal weight?
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What date would you like to achieve this by? (Realistic & healthy fat loss is achieved at a rate of 0.5 - 2lbs per week. If you choose a date that is not realistic or healthy, I will choose a more realistic date for you when building your plan). Leave blank if you have no set date in mind and we will an appropriate target.
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Month
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Day
Year
Date
How would you describe your weekly purposeful exercise level?
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Very Light (Almost no purposeful exercise)
Light (1-3 hours of gentle to moderate exercise)
Moderate (3-4 hours of moderate exercise)
Intense (4-6 hours of moderate to strenuous exercise)
Very intense (7+ hours of strenuous exercise)
How would you describe your daily activity level, excluding purposeful exercise?
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Very Light (Sitting most of the day - eg, desk job)
Light (A mix of sitting, standing, and light activity - eg, teacher)
Moderate (Continuous gentle to moderate activity - eg, restaurant server)
Heavy (Strenuous activity throughout the day - eg, construction work)
Do you have a dietary preference? (Note: This question is asking what you prefer to eat, NOT what you think is healthiest or best to eat).
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None/anything
Vegetarian
Fully plant based/vegan
Mediterranean
Paleo
Ketogenic
How many meals/times do you generally eat per day?
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Have you ever considered working with a personal fitness/nutrition coach?
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Yes! I have worked with one in the past.
Yes! I am thinking about working with one now.
No! And I am not interested in this.
No! But I may consider it at some point.
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Personalized Nutrition Plan
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