1x Macros Assessment

1x Macros Assessment Questionnaire

Please fill out this form and allow up to 3 days for an email response with your personalized macros and a 30-page food guide to help you hit your macro targets!
Name*

First NameLast Name
Email*
example@example.com
Birthday*

MonthDayYear
Date
Sex?*
Height (feet, inches)*
Current weight (lbs)*
Do you have (or have you ever been diagnosed with) any of the following conditions?*

Insulin resistanceDiabetes (Type 1 or 2)Menopause/perimenopausePCOSHypothyroidismHyperthyroidismAnemiaPost bariatric surgeryOther
Are there any other medical conditions that may impact your progress that you would like to disclose at this time?
Please indicate your primary goal(s):*

Weight lossWeight gainMaintenanceMuscle gainOther
Please describe more specifically what your end goal is (weight, body fat percentage, BMI, clothing size, weight lifted, etc.)*
Have you been tracking your calorie/macro intake within the past 6 months?*

YesNo
If you answered yes to the above question, what is your current calorie and macro (protein, carbs, fat) goals:
How long have you been following these macros?
Please describe your weight loss history (Ex: When was the last time you were attempting to lose weight? What methods of weight loss have typically worked for you? How many times have you attempted a calorie deficit in the past?)*
What macro split do you tend to enjoy more?*

Lower carb, higher fatLower fat, higher carbEqual split between carbs and fat
Have you lost weight over the past 3-6 months?*

Yes, I have lost 0.5-1% per week consistently (or more)Yes, I have lost less than 0.5-1% per weekNo, I have not lost weight but I have been trying toNo, I have not lost weight but I have not been trying to
How would you describe your current activity level?*

Not active (no structured exercise, sedentary most of the day)Minimal activity (1-2 days of structured exercise, sedentary most of the day)Moderate activity (3-4 days of structured exercise, somewhat active during the day)High activity (5-6 days of structured exercise, active during the day)Extremely high activity (7 days of structured exercise, active job on your feet all day)
How many steps do you get on an average day?*

Less than 6,000 steps/day6,000-8,000 steps/day8,000-10,000 steps/day10,000-12,000 steps/day10,000-12,000 steps/dayOver 12,000 steps/day
Please describe your current exercise routine (type, duration, intensity of workouts):*
What challenges have you found when trying to achieve your goals?*
Please list any other information that you think would be beneficial for Tayla to know related to your nutrition or overall goals:

Payment*

Personalized Macros

Calories, protein, fat, carbs, fiber, and water goals. Plus a 30-page food guide.

$75.00 Quantity

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Total

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1x Macros Assessment Questionnaire

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