One Time Macro Count & Consultation Questionnaire

One Time Macro Count & Consultation Questionnaire

Any and all details that you provide to the following questions helps me customize your macro count. Please be as thorough as possible.
Personal Information
Name:

First NameLast Name
Email Address:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Gender:
Preferred Pronouns:
Age:
Height (inches):
Current Weight (lbs.):
What is your occupation?
Health
If applicable, are you perimenopausal, menopausal, or postmenopausal? What symptoms, if any, are you experiencing?
Have you ever been diagnosed with any metabolic disorders? (PCOS, hypothyroidism, hyperthyroidism, etc.)
Any other health conditions (including weight loss surgery and hormonal imbalances?)
Are you currently under the care of a physician? If so, for what are you being treated?
How much has your weight changed in the past 12 months?
Nutrition

It is highly important that you answer the following questions based on how you are currently actually eating, not how you think you should be eating.
Have you tracked your food and/or macros before?
If you currently track calories and/or macros, what are your current targets?
How many meals do you typically eat each day?
Do you have any dietary limitations?
Please describe 2-3 entire days of food that you have had over the last 7 days. Try to include at least one weekday and one weekend day. Be as honest as possible. I need to know how you are actually eating, not how you think you should be eating. No judgment here!
How many ounces of water do you think you drink each day?
Do you drink caffeinated beverages, flavored water, tea, and or soda? If so, what kind and how much?
How many times per week do you drink alcohol?
How many times per week do you typically dine out (including fast food and takeout)?
What is your biggest nutritional challenge?

Other
Do you currently meal prep, meal plan, or use a meal prep service? If so, please describe.
What strategies have you tried in the past to improve your nutrition? What has worked? What has not?
Have you dieted for weight loss in the past 2 years? If so, what diets? How many calories were you consuming? How long did that last? Please provide as much detail as possible.
Have you ever been diagnosed with an eating disorder or struggled with an undiagnosed eating disorder?
Activity

It is highly important that you answer the following questions based on how you are currently and consistently exercising, not how you think you should be exercising.
How many steps do you average each day? If you have a watch or other device that tracks your steps, please average your steps over the past month. If you do not have a way to track your steps, please provide an estimated minimum.
How many hours per day do you typically sit?
How many days of strength training do you regularly perform each week? How long are the sessions? Please provide as much detail as possible.
How many days of cardio exercise do you participate in each week? What type of exercise? How long is each session?
Sleep
How many hours of sleep do you typically get each night?
On a scale of 1-10 (low-high), how would you rate your sleep quality?
What, if any, disruptors to your sleep do you regularly experience? (e.g. bathroom use, co-sleeping children, waking children, insomnia, etc.)
Stress
On a scale of 1-10 (low-high), how would you rate your stress level?
What are your top stressors? How well do you feel like you cope with/alleviate stress?
What are the top 3 things that bring you joy/happiness/stress relief? How do you prefer to recharge?
Goals
What are your health and fitness goals?
Any other specific goals?
Think about your ideal self 2 years from now. How do you feel? What do your days look like? What habits are important to you? What do you feel like? What has changed about your physique and overall health?
Is there anything else that you think would be helpful for me to know? What specific questions do you have for me?
Should be Empty:

One Time Macro Count & Consultation Questionnaire

Personal Information

Health

Nutrition

Activity

Sleep

Stress

Goals