On Boarding Registration Form
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
How did you hear about us?
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Newspaper
Internet
Magazine
Other
Please Specify
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what is your age?
What is you height?
Sex?
Please Select
female
male
What is your goal? (example: performance, aesthetics, etc.)
Why do you want to hire a nutritionist?
How much do you workout a week and why type is it? (ex: I weigh-lift five times a week for a 1hr and a half exertion
What would you like to know more about nutrition?
What days are your off days for exercise?
What vitamins and supplements do you take?
Describe your relationship with how you view your body and food?
How much sleep do you get at night?
How much do you weight?
Describe your knowledge of counting calories and macros?
What hobbies do you like to do?
Do you have any allergies?
Rate your stress level from 1-10
How many Oz of water do you consume a day?
What are three things your do well in life?
What are three things that need improvement?
How many steps do you get in a day?
Do you have any injuries or limitations?
How would you describe yourself? (procrastinator, workaholic, easy going etc.)
From Sunday-Sunday describe your whole week? (ex: Monday I do back squat, abbs, and mobility. Tuesday I..) The more detail the better!
What are your expectations with hiring a nutrionists?
How much alcohol do you consume?
Whats your love language? (words, gifts, service, physical touch, quality time)
Describe your family dynamic? (Do you have a good relationship with your parents, are you and your brother distant, etc)
When was your last period cycle?
What do you do for your job?
What meals do you enjoy eating?
What are some barriers that have made it difficult to reach your goals?
Anything additional I need to know about you friend?
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