Nutrition Consultation
Please fill out with as much detail so that I can prepare for our 30 minute session together.
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First & Last Name *
Phone Number *
Email *
Today's Date *
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Age *
Height *
Weight *
How many Meals do you eat in a day? *
Do you currently track your Macros? *
Do you know how many calories you consume in a day?  *
How much protein in grams do you have daily? If you don't know grams, do you have a serving with each meal? What is the type of protein? Ex. chicken, beef eggs, dairy etc. *
How much carbohydrates in grams do you have daily? If you don't know grams, do you have a serving with each meal? What kind of Carbohydrates do you eat? Ex. pasta, rice potatoes, bread, etc. *
What Fats do you eat? *
How many meals do you eat out each week? Which restaurants do you frequent the most? *
How much water do you drink daily? *
What is your average daily step count at?  *
Do you do any resistance training? If so, is it at home or in a gym? *
What is your goal with your diet? Weight loss? how much weight do you want to lose? Building Muscle? How much muscle do you want to build? Health? be specific *
On a scale of 1-10 rate your hunger daily *
Not Hungry
Always Hungry
On a scale of 1-10 rate your sleep *
Terrible Sleep
Amazing Sleep
On a scale of 1-10 rate your energy *
No Energy
Lots of Energy
On a scale of 1-10 rate your mood *
Normal Mood
Mood Swings
On a scale of -10 rate your cravings
No Cravings
Lots of Cravings
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What supplements do you take? Do you want me to make any recommendations for supplements? *
Any additional information you want to provide me with?
Past diets you've tried. Current diets. Current medications. Etc.
 *
What questions do you have for me? *
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