One-Time Nutrition Consultation

One-Time Nutrition Consultation

Detailed Questionnaire
Full Name

First NameLast Name
Best email to reach you
Gender

Other
Age
years
Height
inches
Current weight
lbs
Overall goals: Please include any specific goals for your training and/or body composition:
NUTRITION
Are you familiar with counting macros?
If so, please provide the last set of macros you used, and a little history on your success/failures with macros
What is a typical breakfast?
Do you eat lots of greens on a daily basis?
How many caffeinated beverages do you consume a day?
How many times a week do consume alcohol?
Do you take any supplements?
If so, please state which ones
On average, how much water do you drink a day?
List any food allergies/intolerances
SLEEP
On average, how many hours of sleep do you get a night?
Do you have issues staying asleep through the night?
What time do you usually go to sleep?
How would you rate your sleep quality?
How would you rate your energy levels when you wake up in the mornings?
How would you rate your energy levels throughout the day?
STRESS
On a scale of 1-10 what would you rate your general level of anxiety/stress?
How stressful do you consider your job?
Are there any other things that cause you notable stress?
Do you feel you sometimes turn to food to conceal your emotions?
IMPORTANT
EXERCISE
Whats the activity level at your job?
How many times a week do you exercise/move with some intensity?
Which kind(s) of exercise/movement do you do and for how long?
GENERAL HEALTH
Are you currently pregnant or breastfeeding?
If you are currently pregnant, which trimester are you in?
If you are currently breastfeeding, please provide further details (i.e are you exclusively breastfeeding? How is your milk supply? Are you on a dairy/soy-free diet? How many more months do you plan on continuing to breastfeed?)
Are you a current cigarette smoker?
If you have any injuries, please list them.
Do you have any current diagnosed medical conditions? If so, please list them.
If you are on any medications, please list them.
Please rate your readiness for change
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WIP Nutrition Coaching
Thank you for completing the questionnaire! Once payment is submitted, I will prepare your personalized nutrition plan within 24-36 hours. It will be sent to the email you provided.

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One-Time Nutrition Consultation

NUTRITION

SLEEP

STRESS

EXERCISE

GENERAL HEALTH

My Products