NKD NUTRITION CONSULTATION FORM

Please complete with as much detail as possible.

First Name *

Last Name *

Email *

Instagram

Phone *

Date of birth *

Address *

City *

Postal code *

Current Weight (in kgs) *

Current hip measurement in cm *

Height *

What is your goal whilst working with NKD Nutrition *

When would you like to achieve this by? *

What is your current activity level? *

Sedentary (less than 30 minutes of intentional exercise per day, non active/ desk job)

Lightly active (at least 30 minutes intentional exercise or walking, standing for most or part of the day

Moderately active (Intentionally exercising/ walking per day, active job)

How many steps on average do you do per day? *

What is your current diet? (Number of calories, grams protein/carbohydrates/fats) If you are not sure please list the foods you have eaten over the past 3 days *

Are you gaining, maintaining or losing body weight on your current diet? *

Gaining

Maintaining

Losing

What supplements (if any) are you currently taking? *

Do you have any injuries or physical limitations *

Do you have any food intolerance/ allergies or specific diet choices? *

Do you track your menstrual cycle? *

Yes

Are you currently on any contraception. Please state. *

Do you have regular periods? *

Do you have any known menstrual disorders? Please state *

Progress pictures

You may not be massively comfortable sending these the first time, but trust me, you'll be thanking me at a later date when you can look back on how far you've come. This also enables me to be able to see the visual changes you're making so that I can coach you better. The process of taking progress pictures is completely non-negotiable because of the benefits it provides for you in the long term and without them I cannot coach you effectively. To set yourself up properly for these check in photos, please make sure they fit the following criteria.

Non-negotiable checklist:- Full length pictures - including head and knees (this ensures it's your full body) Front, Side and Back (with hands by your sides) Clear background - ideally a plain wall or door - No selfies Clothing to wear: Sports bra and shorts - with the shorts below the belly button. Low waisted. Please choose something that you are going to wear for each progress photo, and take it in the same position each week - this will enable a clearer picture of your progress.

To get pictures without needing someone else: Prop your phone against something steady like a water bottle, put the timer setting on (Pretty much all smartphones now have a 3 or 10 second timer) - Place your phone in selfie mode, set the timer, step back into the positions mentioned above.- Ensure the phone is at chest height. If you need someone else to take the pictures, use the information above to ensure the pictures fit the criteria - taken from your chest height and shows both the head and below the knees.

I understand

Front Image *

Side image *

Back image *