Macro Coaching Questionnaire

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Name* This field is required.

First Name

Last Name

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Email* This field is required.

example@example.com

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Cell Phone* This field is required.

Area Code

Phone Number

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Date of Birth* This field is required.

Date

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Out of all of these goals, which is the most important to you?* This field is required.

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Do you have a specific timeline for achieving that goal? If so, please specify:* This field is required.

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What do you see being the biggest challenges for you to accomplish your goal?* This field is required.

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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Is there anything else you would like to tell us about your health and fitness goal(s)?

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Do you have any diagnosed health problems, list condition(s). (Diabetes, heart disease, high blood pressure, hypothyroidism, etc)* This field is required.

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Do you have any physical limitations? (asthma, bad knees, back, wrists, etc)* This field is required.

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List any medications you are currently taking.

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Any additional health information you would like to share? (Hereditary diseases, hunches on potential issues, food allergies)

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What do you do for a living/occupation?* This field is required.

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How would you best describe your activity level during the day?* This field is required.

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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Does your work involve shift work?* This field is required.

Yes

No

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Describe your work schedule, hours worked, time of day, days per week.* This field is required.

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Do you travel for work, if so how much?* This field is required.

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Tell us a bit about your family, if you have one, and weekly activities that you do with them? * This field is required.

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When do you typically go to bed?* This field is required.

Hour

Minutes

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When do you typically wake up?* This field is required.

Hour

Minutes

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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?* This field is required.

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Who does the grocery shopping in your house? Who does the cooking? Do you have any meal prep routines?* This field is required.

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Explain your fitness/exercise routine? What kinds of workokuts do you do? How frequently? Are you working with a trainer?

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Do you take any nutritional supplements? If so, what supplements and what dosage?* This field is required.

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How many times a week do you eat out at restaurants?* This field is required.

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Do you follow any dietary guidelines? Vegan, Paleo, Pescatarian, etc? Also explain if you have any known food intolerances or foods you avoid. * This field is required.

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Have you ever tracked calories and macros before?* This field is required.

YESNO

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Do you own a food scale?* This field is required.

YESNO

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If you are currently tracking calories and macros, how long have you been tracking?

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If you are currently tracking and in a calorie deficit, how long have you been eating in a deficit?

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Are you married or in a relationship with someone?

Yes

No

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Are they supportive of your desire to get healthy??

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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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