Name Age Height Body Fat % (If known) Phone Number Email Start Weight Goal Weight Choose the option that best describes the intensity of your workouts Low intensity: Heart Rate between 80-100 bpmModerate intensity: Heart Rate between 100-130 bpmHigh intensity: Heart Rate between 130-160+ bpm Choose the option that best describes your exercise I exercise at a low intensity for 30-60 minutesI exercise at a low intensity for 60-90 minutesI exercise at a moderate intensity for 30-60 minutesI exercise at a moderate intensity for 60-90 minutesI exercise at a high intensity for 30-60 minutesI exercise at a high intensity for 60-90 minutes Which option below best describes you I move a lot at my job, and exercise at least 1-3 times a weekI move a lot at my job, and exercise at least 4-7 times a weekI sit a lot at my job, but exercise 1-3 times a weekI sit a lot at my job, but exercise at least 4-7 times a week Use this space to explain in more detail anything you feel is important regarding the above question Use this space to explain in more detail anything you feel is important regarding the above question Favorite Must eat Foods? Are there any foods you hate and will not eat? Currently how many times a day are you eating? How many times a day is it possible/comfortable to eat. Please pick a number 1 through 6. Do you have time to eat in the morning? How many times a week do you consume alcohol? Do you have any nighttime binge eating issues? If yes, what kinds of food do you eat? How many hours a night are you sleeping? Is it possible to increase hours of sleep if needed? If applicable, please list any allergies you have. Is there any questions you have for me about nutrition programming? Send
