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Macro Coaching Questionnaire
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34
Questions
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1
Name
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First Name
Last Name
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2
Email
*
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example@example.com
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3
Cell Phone
*
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Area Code
Phone Number
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4
Date of Birth
*
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-
Date
Year
Month
Day
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5
What goals do you hope to accomplish?
*
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Fat Loss
Increased Strength
Increased Muscle Mass
Weight Gain
Better Digestion
More Energy
Better Sleep
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6
Out of all of these goals, which is the most important to you?
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7
Do you have a specific timeline for achieving that goal? If so, please specify:
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8
What do you see being the biggest challenges for you to accomplish your goal?
*
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Consistent Exercise
Diet
Time Management
Meal Planning
Checking in with us
Support from family, friend, coworkers
Staying focused on weekends
Nothing, I'm ready to go
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9
Is there anything else you would like to tell us about your health and fitness goal(s)?
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10
Do you have any diagnosed health problems, list condition(s). (Diabetes, heart disease, high blood pressure, hypothyroidism, etc)
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11
Do you have any physical limitations? (asthma, bad knees, back, wrists, etc)
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12
List any medications you are currently taking.
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13
Any additional health information you would like to share? (Hereditary diseases, hunches on potential issues, food allergies)
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14
What do you do for a living/occupation?
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15
How would you best describe your activity level during the day?
*
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None, sedentary job, little activity at home
Moderate, light activity during the day and at home
Active, on your feet most of the day but nothing strenous
Heavy, on your feet and doing strenuous activity throughout the day
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16
Does your work involve shift work?
*
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Yes
No
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17
Describe your work schedule, hours worked, time of day, days per week.
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18
Do you travel for work, if so how much?
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19
Tell us a bit about your family, if you have one, and weekly activities that you do with them?
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20
When do you typically go to bed?
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Hour
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Minutes
AM
PM
AM
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PM
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21
When do you typically wake up?
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Minutes
AM
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PM
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22
Describe your wake up routine. Do you need an alarm clock? Do you pop out of bed right away? Basically is waking up hard and how rested do you feel?
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23
Who does the grocery shopping in your house? Who does the cooking? Do you have any meal prep routines?
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24
Explain your fitness/exercise routine? What kinds of workokuts do you do? How frequently? Are you working with a trainer?
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25
Do you take any nutritional supplements? If so, what supplements and what dosage?
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26
How many times a week do you eat out at restaurants?
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27
Do you follow any dietary guidelines? Vegan, Paleo, Pescatarian, etc? Also explain if you have any known food intolerances or foods you avoid.
*
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28
Have you ever tracked calories and macros before?
*
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YES
NO
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29
Do you own a food scale?
*
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YES
NO
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30
If you are currently tracking calories and macros, how long have you been tracking?
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31
If you are currently tracking and in a calorie deficit, how long have you been eating in a deficit?
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32
Are you married or in a relationship with someone?
Yes
No
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33
Are they supportive of your desire to get healthy??
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34
Thank you for taking the time to fill out this form and let us know more about you. If there is anything else you would like to let us know about concerning your diet, health, fitness, family, routines, work or whatever please do so below.
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