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Nutrition Application
Please fill out the application form as honestly as possible.
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Social media handle
*
Your answer
Last Name
*
Your answer
Time zone
*
PST (Vancouver/Seattle)
MST (Calgary/Montana)
EST (Toronto/New York)
GMT (Ireland/UK)
Other:
Gender
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Female
Male
Prefer not to say
Other:
When is your birthday?
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MM
/
DD
/
YYYY
Are you an athlete and/or are you currently training for a sport or athletic event?
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Yes
No
If Yes, when is the event deadline or goal date?
MM
/
DD
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YYYY
In general, what are your goals? (Click all that apply)
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Lose weight/fat
Gain weight
Gain muscle
Maintain weight
Improve overall health
Improve physical fitness
Improve hormone health
Improve immunity
Improve digestion
Look better
Feel better
Have more energy and vitality
Healthy aging
Get control of eating habits
Other:
Required
Let's get a little more specific. How would you like your body, health and/or wellness to be different?
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Your answer
Out of all those changes, which one or two are most urgent/important to you?
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Your answer
Have you tried anything in the past to make these changes? If so, what?
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Your answer
Which of those things worked well for you? (even just a little bit, and even if you're not currently doing it)
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Your answer
Which of those didn't work well for you and why not?
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Your answer
In your own words, what do you think is currently stopping you from reaching your health goals?
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Your answer
As of today, how would you rank your overall eating/nutrition habits?
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The worst.
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So awesome!
For the question above, why?
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Your answer
What you are NOT willing to do when it comes to your nutrition/diet habits? (Select as many as apply)
*
drink more water
change my diet camp (vegan, paleo, keto etc)
take photos of my meals
track my calories
track my macronutrients
track my food in a journal
track my food in an app
prep my food ahead of time
eat only from home prepared meals
give up sugar
give up alochol
take suppliments
get a stool sample
eat more protein
eat more whole foods than I currently am
Other:
Required
How much 'intentional' physical activity do you do each week? (physical jobs or day to day movement does not apply to this. Walking, lifting, biking etc DO count)
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Less than 3hrs
Between 3-7hrs
More than 7hrs
Are you currently on a resistance training program? (either at your own leisure or with a PT/coach.)
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Yes
No
What other activities do you do or enjoy? (click all that apply)
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Cycling
Hiking
Swimming
Soccer
Frisbe
Rock Climbing
Dancing
Yoga
Other:
Required
How READY are you to change your behavior and habits?
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0
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10
How WILLING are you to change your behavior and habits?
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0
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10
How ABLE are you to change your behavior and habits?
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0
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9
10
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