Welcome to Jen Swift Nutrition Coaching
Please fill out this form & hit submit. ‼️IMPORTANT PLEASE BE ON THE LOOKOUT FOR AN EMAIL FROM ME TO FOLLOW UP FOR A FREE 30 MINUTE CONSULTATION. 😊
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Instagram Handle
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Please list your gender, age, height & weight
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(F, 46, 5'3, 125)
Current Nutrition Habits
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(tracking macros, using WW, etc.)
Any experience in tracking macros?
No experience
1-6 months
Very Knowledgable in tracking macros
What are your current goals for the next 6 months?
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What are your long term goals? What do you envision for the next year?
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Areas in your life you are looking to improve on?
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Fat Loss
Maintenance weight
Muscle Building or Surplus
Lifestyle Change/making healthy habits
How serious are you when it comes to reaching your goals?
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Count me in, I'm ready to go full speed ahead!!
I'm a bit overwhelmed, but ready to make a change!
Not sure I have enough determination yet.
Not ready.
Tell me about your struggles.
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I've tried every diet & nothing is working!
I eat well during the week & lose all control on the weekends.
I don't sleep well.
I'm always stressed.
Other
What do you spend most of your days doing?
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(sitting at a desk job, standing, walking, etc.)
What is your current workout routine? Be specific.
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(Lift weights 4 days a week, walk for 45 minutes each day & cardio 30 mins 3 days a week)
How many steps do you average on a daily basis?
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What are you looking for in a coach?
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(someone to hold you accountable, offer support, encourage you, offer a tough love approach)
Are you fully prepared to commit to this program in order to achieve your goals?
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YES
NO
Please list any health conditions that may affect your program: (Ex: PCOS)
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Is there anything else I should know about you? Please share, I'm here to help!
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Current program information provided by Jen Swift Macro Nutrition Coaching is not intended to diagnose, prevent, treat or cure any health related problems. Please consult with your physician before starting this program. You must be at least 18 years of age. By selecting "YES" you agree to all the above terms.
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YES
NO
Submit
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