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What is your age?
What is your height?
What is your current weight?
What are you currently experiencing? (Check as many that apply)
Low energy
Major cravings
Lack of sleep
Weight gain
Unable to lose weight
Struggling to gain muscle
Other
What is your main goal? (lose weight, gain weight, tone up, athletic performance, overall health, etc)
What are your obstacles/challenges in achieving your goal?
How many meals do you typically eat per day?
How many calories do you eat/day? Its ok if you don't know. Just simply state so.
How would you rate your daily protein intake on a scale of 1-10? (1=hardly anything, 10 = 1g/target weight)
What type of carbs do you typically eat? (Rice, bread, pasta, potatoes, etc)
What diets have you tried in the past?
What is your current workout routine?
How many hours do you sleep/night?
What is your stress level on a scale of 1-10? (1=no stress, 10 = I'm burnt out)
Are you interested in getting coaching support?
Do you have any dietary restrictions or allergies?
Do you take time for self-care? If so, what are your go to's (nails, lashes, facials, gym, coffee, etc)
List any additional information that may be relevant