Nutrition Intake Form.

This is the first step in becoming the best YOU!

Be as detailed as possible with the following questions. The more information you provide, the more I can help you!

Name

First Name

Last Name

Phone

(###)

###

####

Instagram Handle

To add you to the nutrition group

Are you currently following a specific diet?

If so, explain

Do you have any allergies or food intolerances?

If so, explain

What does a typical day of eating look like for you?

Provide as many details including timing as possible.

What is your activity level?

Describe your weekly workout plan & how active you are during the day/ at work.

How often do you cook at home/ eat out?

How much alcohol do you drink per week?

How much water do you drink per day?

Do you take any supplements?

If so, provide details of which ones

How many hours of sleep do you get per night?

What are your current goals?

What is your biggest obstacle?

Have you ever tracked your macros or calories in the past? Would you be interested in tracking?

Explain with detail

Answer this: In 6 months I hope to...