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/dinners meals List your favorite 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! *
Example: 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 & dairy alternatives *
Example: goat cheese, greek yogurt, oat-milk…
Foods 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? *
List your favorite restaurants
Cafes & Restaurants. You’ll have the opportunity to add to this list.
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? *
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, dates and the airport.
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.
Weekly Coaching Calls Scheduling *
Select any/all options that work best for you! Weekly calls are scheduled on the same day EACH week for 45 mins. (12 total sessions)