Nutrition Consult
This form helps me understand your goals, lifestyle and current nutrition so I can determine if nutrition coaching is the right fit for you. Please answer honestly — there are no right or wrong answers.
Fuel Nutrition Coaching is not open enrollment.
Clients are selected based on readiness, alignment and commitment. Intake is capped.
Customer Details:
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Gender?
Male
Female
Coaching Intent & Goals
Fat Loss
Muscle Gain
Improve Energy Levels
Improve Performance
Improve Relationship With Food
General Health
“If we worked together for 12 weeks, what would success look like to you?”
Timeline expectations:
I’m happy to play the long game
I’d like noticeable changes in 6–8 weeks
I need short-term structure first
Nutrition History:
No structure, I wing it
Tracking calories/macros
Following a meal plan
If you could wave a magic wand, what would you FIX or CHANGE about your body and performance?
Consent & Disclaimer:
I confirm the information provided is accurate and understand that nutrition coaching is not a substitute for medical advice.
I understand results require consistency and personal responsibility.
Apply For Nutrition Coaching
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