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First Quarter Accountability Challenge
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Indicates required field
Name
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First
Last
Email
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Phone Number
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What is your age?
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Current Weight?
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Height?
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Gender?
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Female
Male
What are your goals?
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Lose weight (lose at least 10-15 lbs)
Body Composition Change (lose 10-15 lbs or less while building muscle)
Gain Muscle Mass (Build muscle and increase overall body weight)
Improve Health (improve health and maintain current body weight)
Check all that apply.
Ladies only: Do you still have a period?
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Yes, regularly
Yes, but they are irregular
No, I do not have periods
Ladies only: Have you ever had your hormone levels checked?
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Yes
No
Dietary Preference?
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Anything
Ketogenic
Vegan
Vegetarian
Paleo
Goal Weight (if goal is to Lose Weight or Gain Muscle Mass)
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Hit me with your "WHY?" What do you hope to get out of this challenge? (other than the pot o' money)
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Tell me about a typical day for you. For example: Wake at 6 am, work from 7am-4pm, walk my dog about 1/2 mile, dinner by 6, Netflix by 7pm, bed by 9pm.
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How many days a week do you plan on working out during this challenge?
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How many times would you like to eat per day? (2-8)
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If you workout outside of our time together, describe a typical routine.
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Please add any questions or other notes you'd like to add here. Be open and honest, the more data I have to work with, the better I can prescribe your calorie/energy intake!
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Submit
HOME
NUTRITION COACHING
TRAINING + YOGA
NEW CLIENT SURVEY
ABOUT ME
Blog
