Macro Focus, Macro Focus+, & Macros + Meals
Name
*
First Name
Last Name
Email
*
example@example.com
Cell Phone
*
Format: (000) 000-0000.
Health Goals
What goals do you hope to accomplish?
*
Fat Loss
Increased Muscle Mass
Weight Gain
Maintain Current Weight
Other
Out of all of these goals, which is the most important to you?
*
Do you have a specific timeline for achieving that goal? If so, please specify:
*
What do you see being the biggest challenges for you to accomplish your goal?
*
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
Other
Is there anything else you would like to tell us about your health and fitness goal(s)?
Medical and Health Information
Age
*
Height
*
Current Weight
*
Sex
*
Male
Female
Do you have any diagnosed health problems, list condition(s). (Diabetes, heart disease, high blood pressure, hypothyroidism, etc)
*
Do you have any physical limitations? (asthma, bad knees, back, wrists, etc)
*
List any medications you are currently taking.
Any additional health information you would like to share? (Hereditary diseases, hunches on potential issues, food allergies)
Lifestyle Information
What do you do for a living/occupation?
*
How would you best describe your activity level during the day?
*
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
Tell us about your exercise/activity routine. How frequently do you complete these exercises/activities?
*
Diet and Nutrition Information
Do you take any nutritional supplements? If so, what supplements and what dosage?
*
Do you follow any dietary guidelines? Vegan, Paleo, Pescatarian, etc? Also explain if you have any known food intolerances or foods you avoid.
*
How many times a week do you eat out at restaurants?
*
What type of food choices do you typically make? (frozen foods, fresh options, grab-and-go, homemade, microwavable, meal prep, etc.)
How many ounces of water do you consume per day?
*
Macronutrient and Calorie Information
Do you own a food scale?
Yes
No
Have you ever tracked your calories or macros before?
Yes
No
Have you ever had your macros calculated before? If so, where did you receive your results? (internet app, trainer, CNC, dietician, etc.)
*
If you are currently tracking calories and macros, how long have you been tracking?
How do you track your calories? Be specific. (apps, journal, guessing, etc.)
Macro-Coaching Plans
Which macro-coaching plan/s are you interested in?
*
Macro Focus
Macro Focus+
Macros + Meals
*Macro Focus+: Which program plan are you considering?
3-month
6-month
Quarterly
Annual
Macros + Meals (Optional)
If interested in Macros + Meals add-on, how many meals are you looking for in any given week?
7
14
Which meal category/categories are you interested in? (Select all that apply.)
Breakfast
Lunch
Dinner
Submit
Should be Empty: