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Help me get to know you:
Please fill out the following information to help me understand your health, lifestyle, dietary habits, and goals.
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Name
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Your answer
E-mail Address
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Your answer
Phone Number
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Your answer
Gender
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Male
Female
Age
*
Your answer
Height
*
Please enter in Feet and Inches:
Your answer
Weight
*
Your answer
How active are you during the day?
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Sedentary (Little to no physical activity; desk job with no exercise,)
Lightly Active (Light exercise 1-3 days per week; walking, casual cycling, or housework)
Moderately Active (Moderate Exercise/ sports 3-5 days per week; Teacher or sales person)
Very Active (Hard Exercise / sports 6-7 days per week; Construction, landscaping)
How many hours do you sleep per night?
Your answer
What are your primary health and nutrition goals? (e.g., weight loss, muscle gain, more energy)
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Weight Loss
Muscle Gain
More Energy
Body Recomposotion
Other:
Why are these goals important to you?
Your answer
Do you have any food allergies or intolerances?
Your answer
How many meals and snacks do you eat daily?
Your answer
What are your favorite foods?
Your answer
What foods do you dislike or avoid?
Your answer
Do you have any diagnosed medical conditions? (e.g., diabetes, hypertension, thyroid issues)
Your answer
I understand that the information provided during coaching sessions is not a substitute for medical advice. "Please type your full name as your electronic signature."
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Your answer
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