One Time Macro Count Application

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Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
What is your Instagram name? Type "N/A" if you aren't on Instagram.* This field is required.
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When is your birthday? (How old are you?)
6
Have you counted macros in the past?
YESNO
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What are your health/fitness goals?* This field is required.
Lose weight
Gain weight
Maintain weight
Feel better
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What is your dieting history (What have you tried in the past? For how long?)* This field is required.
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Ok
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Are you on any special diet currently? (Ex. vegetarian, no dairy, keto, etc.)
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Ok
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What do you do for work? What are your typical hours?
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Ok
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How tall are you?
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How much do you weigh?
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How many steps do you get (on average) each day?
0 - 3000
3000 - 6000
6000 - 9000
9000+
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Do you have any medical problems?
YESNO
15
If yes, what conditions(s)? If not, type "N/A".
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What type of exercise do you get? Describe in detail. (If strength training, what kind/program and how many days per week? If cardio also, what kind and how many days per week?)* This field is required.
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Ok
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What are your nutrition frustrations/road blocks?
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Ok
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Roughly how many times have you been on a diet in the last year?
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Ok
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What are your hobbies?* This field is required.
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Ok
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Is there anything else you'd like me to know about you?
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Ok
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Were you referred by someone? If so, who? If not, type "N/A".* This field is required.
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Ok
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My one time macro count is $70 and it is for those who are motivated to hit goals on their own. This is not ongoing coaching and you will not receive continued guidance from me beyond the one time count.* This field is required.
Yes! I understand and I'm ready to do this!
I'm nervous but would like to try this on my own.
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One Time Macro Count
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Total costUSD
One Time Macro Count
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Please note that you will be added to my email list. You may choose to unsubscribe at any time. You will also receive your one time count via email. Make sure to check your spam!
Add me to the list!No, thank you.
25
Payment Methods
Debit Or Credit Card
Select PayPal Method
Choose from one of the PayPal options to make your payment.
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