Questionnaire
Hey! Thanks for choosing us to help you start your journey towards a healthier lifestyle. Whether your goal be weight loss, weight gain or fuelling for performance we are here to help and guide you. Try and answer the following questions in as much detail as possible.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
Email
*
example@example.com
Are you interested in joining our Everyday Program or Performance Program?
Everyday Program
Performance Program
I'm Unsure
Is there a particular coach you wish to work with?
Emeli
Callum
Dalton
No preference
Date Of Birth
*
Height
*
Weight in KG
*
How did you hear about us? Were you referred by someone? Do you know of anyone else who would be interested in being a part of this program? Please provide contact information below (name, number, email address).
*
What are your nutrition goals? Do you have any mindset goals? Please be as specific as possible.
*
Do you have a goal weight?
*
If yes, what is your goal weight?
If yes, what is your goal weight one month from now? 3 months? 6 months?
Do you have any training goals? What is the purpose of your training?
*
What is your primary focus / goal throughout your nutrition coaching experience? Is it performance? Overall health & wellness? Weight loss? Fat loss?
*
Do you have any medical conditions or injuries? (*Females - Please include if you have been pregnant or are currently pregnant, how many months postpartum, & if you have had a c-section*)
*
Does your family have any medical and/or health conditions? e.g. diabetes, high blood pressure, etc.
*
Please list any medications you take, including GLP-1s (ozempic etc.)
*
What do you do currently outside of exercise that is active? - Walking, Active Job, Etc...
*
What do you feel would be your biggest obstacle whilst working towards your goal - be honest!
*
How many days a week do you to train? Include your rest days.
*
Do you have any medical problems or conditions?
*
Do you have any food allergies or sensitivities?
*
If yes, please give details...
How many years have you been training? What is your fitness history? What type of workouts/training do you do? How many times a week do you train? What time do you train and for how long? Please describe with as much detail as possible.
*
Please describe your history and current relationship with food. (e.g. always been a healthy eater, tend to crave sugar, have been dieting for years, etc.)
*
Do you consume alcohol? If so, what kind, how much and how many days per week?
*
Please provide an example of your daily food intake.
*
Do you work full-time? Part-time? Are you a parent? How many hours a week?
*
On average, how many hours do you sleep per night? Do you have any issues with or poor sleeping habits? Are you able to establish a sleeping routine? (e.g. same bedtime/wake up time)?
*
Do you take supplements? If so, please list them. Are there any supplements you won't take? Are you willing to add supplements/protein powder into your current budget?
*
Are there any obstacles/challenges in your day to day that affect eating, times of eating, working out etc.? (e.g. some days I am so busy with work I only eat once, I can’t find time to workout.)
*
Prior to starting with us, we ask for “before pictures”. These are for our internal use only and will not be posted. Would you be comfortable with this?
*
Part of our coaching requires an understanding of your expectations. Please describe your expectations of our coaching experience (e.g. you expect to reach your coach through text and email, you prefer a once a week check in and a more hands off approach, you hope to lose weight, gain muscle, and have a coach that pushes you and is in constant communication)
*
Please confirm you have disclosed all medical conditions. You also understand that FPN has a no refund policy for customised nutrition programs and that all payments made are non-refundable.
*
Signature
*
Continue
Continue
Should be Empty: