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Consultation Form

First name*

Last name*

Email*

Phone*

Birthday*

Month

Day

Year

How often do you currently exercise? *

0 times per week

1-3 times per week

4-7 times per week

I am looking to *

Get Healthy

Lose Weight

Build Muscle

Improve my Overall Fitness

Do you meal prep?*

Yes

No

Have you ever tracked and measured your food intake? *

Yes

No

Do you eat food or have drinks with high sugar on a weekly basis?*

Yes

No

Do you eat processed foods?*

Yes

No

Do you need help understanding what foods to eat to be healthy and fit? *

Yes

No

What is the best time to workout for you?*

Morning

Afternoon

Evening

Can you do 10 push-ups?*

Yes

No

Can you do 1 pull up?*

Yes

No

Can you easily run 1 mile?*

Yes

No

Give me a example entry of what you eat on a regular week day*

What are your fitness goals?*

Do you have any injuries? If so, explain any limitations, what caused it, brief history of what causes you pain and what exercises cause it to hurt. *

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