Intake form:
First & last name
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Email
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Phone number: (please double check for typos as I will be contacting you via this number)
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Location(city+state):
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Height:
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Weight:
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Age
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What coaching services are you interested in?
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Training+ Nutrition
Nutrition only
Training only
What does your current diet consist of? If you have current macros or a meal pan please list length of time you have been following. If not give a general sample day of eating with estimated amounts if you can:
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What is your dieting history over the past few years? What were your results?
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Describe current training: split/ days per week/training intensity (sets to failure/intensifiers etc.), time of day you normally train?
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Current cardio regimen? (Type,days per week, length of time, intensity)
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What’s your average daily step count?
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Are you on any form of birth control? If so what kind and for how long? (If male or not on any type of”N/A”)
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Any history of eating disorders?
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Any history or use of PED’s?
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What are your long term goals? What are your short term goals?
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Have you had bloodwork done in the past 6 months?
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Please list out all health supps you’re currently taking with dosages:
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Anything you feel I should be aware of?
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Food allergies?
For those interested in nutrition coaching : Please give me a list of (clean) foods you love and foods you dislike (type “N/A” of not interested in nutrition)
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Submit
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