Email * Phone Height * Food Preferences
Please list in details what you love & enjoy to eat. Even if it does not “sound” healthy! All of your fav foods! When you get to the macro portion- select everything you currently eat and would be open to trying!
List your favorite BREAKFAST meals List your favorite LUNCH& DINNER meals What types of PROTEIN do you enjoy eating? *
Select ALL that apply
List your favorite CARBS! *
…sweet potatoes, quinoa, brown rice, tortilla…
List your favorite FATS! *
…avocado, olives, cheeses, coconut oil, peanut butter..
List your favorite FRUITS & VEGGIES * List some of your sweet/salty cravings. * When do you usually have these cravings? * Favorite DAIRY foods, or DAIRY ALTERNATIVES. *
..goat cheese, greek yogurt, oat-milk..
Foods or beverages you CANNOT go without! Favorite foreign dishes
Example: Pakistani/Indian, Mediterranean, Asian, African…
Beverages you enjoy!
Example: Non-alcoholic (coffee, fresh juices, tea, smoothies) & Alcoholic
How many alcoholic drinks do you consume each week? *
Are you currently taking edibles or smoking marijuana? *
Are you currently smoking nicotine? *
List your favorite restaurants
Cafes & Restaurants.
Preferred Grocery Stores *
Select ALL that apply
Add any additional stores you'd like to add?
Links to store website is appreciated!
Appliances you have available * How many recipes would you like on your plan? * 1 Breakfast, 1 Lunch, 2 Dinners 2 Breakfasts, 2 Lunch, 2 Dinners 2 Breakfasts, 1 lunch, 2 Dinners 1 Breakfast, 2 Lunches, 2 Dinners 1 Breakfast, 1 Lunch, 1 Dinner
For the week
Would you like to try out prepared meal prep for "back-up &/ or traveling" meal options?
Examples; Snap Kitchen, Hello Fresh
List all physical injuries & weaknesses *
Example: Knee pain, lower back pain..etc
List the people you consider your "support system" Do you have a therapist? Have you ever worked with one? * Upload Any Recent Labs/Blood Work
Upload Photos of any current nutritional supplements and medications you are taking
Example: Protein powders, vitamins, prescriptions..
If you are traveling anytime soon: list locations (ZIP), dates and the airport.
Any details that can help with building a travel plan!
What is your current physical activity schedule? How active are you in general? *
Example: Strength training 3x week, cycling 2x week, Light walking daily, or sitting in a desk all day. Goals: aim for training 3 times a week.
What triggers your anxiety? How often do you experience anxiety? * What does "me" time for you look like? What makes you feel calm, and at ease? *
Example; reading a book, talking to family, praying, meditation..
Do you own a HR monitor/ Step Monitor?
Example: Apple watch, Fitbit, Amazon
Current Energy/Macro Intake (IMPORTANT)
Track 3-4 days of your intake. Preferably 2 week days, and 2 weekend days. Use the “save & resume later” button as you track days before submitting.
Food Diary Weekday 1 *
Example: Breakfast: 2 eggs + 1 cup cooked oatmeal + 1 banana, Lunch: brown rice pasta + 4 oz or hand size chicken breast + vegetables, Snacks: Vega protein bar
Food Diary Weekday 2 * Food Dairy Weekday 3 (optional) Food Diary Weekend 1 *
Example- Breakfast: skipped, Lunch: Burger & Fries from hopdoddy…
Food Diary Weekend 2 * Is there anything else you'd like for your me to know?
ANYTHING you think would help with the program design process.
Please list your availability for weekly coaching sessions. Coaching sessions are 60 min in length each week @ the same time/day.