FIVE STAR⭐ STAGE PHYSIQUE TEAM: INTAKE FORM
I am so excited to work with you!

Please fill out this form so I can customize and personalize the best plan for you.

Sign in to Google to save your progress. Learn more
Name *
Email *
Best Phone Number *
Last Stage weight + Date of show *
Were you happy with that weight /outcome of your last show?  Please feel free to elaborate if needed. *
Goal Weight *
 Height *
Age *
What is your current cardio per week? (Please list # of days and minutes per session) *
What is your current Strength Training per week? (Please list # of days and minutes per session) *
Any other activities you participate in? (yoga, swimming, karate etc.) *
Where do you work out? *
Any medical conditions? *
What prescriptions do you take? *
What supplements do you take? *
Do you have a physician that does hormone testing for you? *
Do you have any food sensitivities or allergies? *
What time do you go to bed? *
Time
:
What time do you wake up? *
Time
:
On average, how many hours of sleep do you get every night? *
How soundly do you sleep?   *
not at all
like a log
Do you take any sleep supplements or prescription drugs for sleep?  Please list. *
Please choose the Food Plan to start with  (you have 3 choices – and they are not mutually exclusive of each other): *
If Option 1: MACROS – Do you have a preference for a certain style of eating [ low carb, medium carbs, carb cycling, plant based, keto, ] if no preference – that is ok too- I am happy to guide the process. (If choosing Option 2 or 3 please skip this question)
If Option 2: MEAL PLAN – Do you have a preference for number of meals daily? Are you PLANT BASED?  (If choosing Option 1 or 3 please skip this question)
If Option 3: NEITHER MACROS or MEAL PLAN Neither and you will be PRE PLANNING your meals please be sure they are planned IN WRITING.  (If choosing Option 1 or 2 please skip this)
What kind of workout support are you looking for? *
Required
Just a few additional questions to help me get to know you better:
Are you a RULE FOLLOWER? Or More of a REBEL? *
Do you want to be held accountable? (scale of 1-10 with 10 being NEED HIGH ACCOUNTABILITY) *
Need Very Low Accountability
Need High Accountability
Do you let the scale get in your head and ruin your day? *
Have you ever had any kind of eating disorder? Please explain if there are details I should know. *
What has been the hardest for you when it comes to bikini comptetition? *
Are you willing to work on yourself even when it’s hard? *
What is the ideal outcome for you in our time together? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms