Metabolic Assessment Form

Name*

First NameLast Name

Email*

example@example.com

Phone Number *

International Dialling CodePhone Number

Instagram Handle*

Put NA if you’re not on instagram

Age*

Current Bodyweight*

Height*

What are your goals? Fat Loss? Build Muscle? More energy? Please give me all the details! *

How much weight are you looking to lose? Or how much weight are you trying to gain? etc.

Are there any specific obstacles or challenges you're facing with achieving these goals? *

How many meals do you usually eat each day?*

How often do you eat out at Restaurants on average every month?

How would you rate your food quality on a scale of 1-10? (10 being perfect)*

How many calories do you aim for daily?*

If you're not sure, thats okay! Just let me know below.

How would you rate your protein intake on a scale of 1-10? (1 being hardly eating any, 10 eating at least 1g per lb of bodyweight daily/2.2g per kg of bw)*

How is your digestion overall? How often are your bowel movements? Do You experience bloating or discomfort on a regular basis? *

How many and what diets have you tried in the last 3-5 years? *

How much caffeine are you consuming daily? ☕️*

How physically active are you?*

Very active, Moderately active, Light, Very Light

Are you currently following a workout plan? If so, what are you doing? *

i.e. Strength train 3x a week, Cardio, Ab workouts, Running, Yoga...

How much sleep do you get on average each night?*

6 hours or less7 hours or less8 hours or more

How would you rate the quality of your sleep on a scale of 1-10?*

1 is Terrible, 10 is Amazing!

How would you rate your Energy Levels out of 10?*

1 is No energy, 10 is feeling amazing!

How would you rate your stress levels on a scale of 1-10? (READ THIS CAREFULLY: 1 is stressed AF, 10 is feeling chilled with minimal stress)*

How do you cope with stress in your life?*

Any other health-related issues I need to know about? Allergies, diet preferences, injuries, hormonal imbalances... etc.*

Have you ever considered working with me as your 1:1 coach?*

Last Question! Where did you find this form? *