Coach Louis' Nutrition Coaching Application

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This form is to learn more about you, the potential client, and see if we best fit together. Please do not hold back any information I may need during this process.

Email *

First Name *

Last Name *

Were you referred by a current client? If so, who?

Gender *

Male

Female

Prefer not to say

Other:

Birthday *

Age *

Height (in inches) *

Current Weight (in pounds [lbs]) *

Facebook Profile Link

Instagram Username

Is your *primary goal* fat loss? *

Yes

What kind of workouts/training do you do? (ie: bodybuilding style, powerlifting, Crossfit, OTF, etc). *

How active are you outside of the gym (1 sedentary -> 10 extremely active) *

Sedentary

Extremely Active

What exactly are you wanting to achieve with coaching from me? What are your goal(s) short term and long term? *

Have you ever worked with a personal trainer (either in person or online)? If yes, what was your experience? *

Do you have any health issues or past injuries we should know about, such as asthma, diabetes, back pain, etc, we should know about? If so, please explain here. *

Please list any medications you're taking. *

Are you pregnant or might be pregnant? *

Yes

Maybe

Is there anything to prevent you from working out? If yes, explain. *

Are you already experienced w/ Flexible Dieting, IIFYM, tracking macros? *

Yes

Are you currently tracking your macros? If yes, what is the calories/macros intake? *

Have you had success or trouble following diets in past? *

Are you an emotional eater? *

Yes

Maybe

Do you binge on food? What's the trigger(s)? *

How often do you consume alcohol? *

Daily

Weekly

Monthly

Rarely

Never

Occasionally

Do you smoke? *

Yes

Occasionally

Do you consider yourself motivated to reach your goal? *

Yes

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