Committed Nutrition 1-1 Coaching

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1-1 Nutrition CoachingPlease complete the following survey to help make the support as specific to your needs as possible
First Name
Last Name
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What sport do you participate in?
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Date of birth
Date
Year
Month
Day
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Height
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Average weight
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Are you currently taking any medication?
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If female, are you on any type of contraceptive, if yes please provide below
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If female, have you ever had an irregular menstrual cycle?
Please Select
Please Select
Yes
No
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If yes, please provide more details below
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Are you currently trying to concieve?
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Have you had bloods taken in the last 6 months?
Please Select
Please Select
Yes
No
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What is your email address?
example@example.com
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What is your phone number?*
Please enter a valid phone number.
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What is your main reason for wanting to be part of our coaching program?
Fertility nutrition support - Pre pregnancy
Pregnancy
Postpartum
Other
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What sport do you participate in and to what level? (e.g. Football- National League)
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How would you rate your motivation to begin a journey that has the potential to be life changing for you?Motivation can be low right now, but we'll rediscover once signed up
Think I know what I'm doing, so it's likely i won't apply your methods
Not willing to make a shift to better habits
Open to making a change but I'm busy and this may hinder progress
I'm looking forward to beginning your coaching program, it is what i need to improve
I'm in. Tell me what to do and I will apply myself to get the best results possible
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Why do you want to work with me what are your specific goals and why?Give us an idea of your goals, especially around your WHY, but don't worry if you don't have clarity as we'll go deeper once signed up
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Is there any information you can give us that will improve our understanding of your journey thus far and where you want to go?What's worked well in the past, what's not worked so well, what seems to get in the way, why are you thinking about change, what's prompted you to change etc
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In 6 months time, what would success look like for you?Improved race time, improved sporting performance, specific weight loss or muscle gain for performance, perception of others towards you, improved fueling and recovery
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Have you followed any specific diets in the past 6-12 months? (e.g. Fasting, Vegan etc)Provide necessary details below
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Have you any food allergies/intolerances/dislikes? If so, please provide details below
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Have you gained or lost a lot of weight in the past 6-12 months?
Please Select
Please Select
Yes, Gained
Yes, Lost
No
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How would you rate your your relationship with food out of 10?10 = Amazing, I am a foodie and 1 = Awful, I punish myself
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Have you signed up with a nutrition coach in the past 12 months? If yes, provide any details which you find would help going forward
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Do you use My Fitness Pal or any other type of food tracking? If yes, please provide username and type below
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What is the biggest barrier stopping you from achieving your goals?
Lack of time
Lack of education
Lack of guidance and support
Lack of clarity with goals
Fear of fuelling
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What price are you willing to invest & put on your health, performance and future self?* This field is required.
£349+pcm
Cost is irrelevant, I just want results
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Instagram handle@committednutritionltd for example
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I understand and agree to the terms of the coaching program as outlined below:Mark x and add name below
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I give consent to signing up to Committed Nutrition coaching programme and I agree to participate in the coaching program and understand the terms and conditions outlined in this document above.Signature below
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