All About You - Nutrition Intake Form

Fill out the All About You intake form ASAP so that I can refer to your info while designing your custom nutrition throughout your program. The more detailed, the better!

NOTE: make sure you have your 'Before' photos taken and ready to upload.

Thank you and I look forward to chatting with you on our Onboarding Call after your intake has been submitted.

Steph

Click the button below to start.

Start

Question 1 of 29

First & Last Name:

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Question 2 of 29

Email address:

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Question 3 of 29

Phone Number

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Question 4 of 29

Instagram username (if applicable):

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Question 5 of 29

When is your ideal start date?

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Progress Tracking

Please upload your "before" photos.

Include a front, back & side view. Have someone take the photos for you or use a self-timer.

Wear a bikini (women) or a short pair of shorts (men), or whatever you're comfortable in.

Please note: these will never be shared or posted without permission.

Question 7 of 29

Upload your front view

Question 8 of 29

Upload your back view

Question 9 of 29

Upload your side view

Your Goals

We want results!

Be as detailed as possible with your goals. You don't have to limit these to fitness & nutrition.

Fitness & nutrition are the foundation to a successful lifestyle overall - relationship success, financial success, confidence, discipline, productivity & more.

When you can define goals outside of fitness & nutrition, and understand your "why", it becomes much easier to push towards your fitness & nutrition goals!

Question 11 of 29

What are your goals and why?

Include:

1. Short term goals (2-4 weeks)

2. Medium term goals (1-12 months)

3. Long term goals (1-5+ years)

Ask yourself why these goals are important to you and include your answer here too.

Paragraph answer

Your Stats

Your nutrition is largely based on your stats - like age, height, weight, activity level, etc.

Give me all the deets so I can calculate your custom macros!

Question 13 of 29

What is your age, height, weight?

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Question 14 of 29

What is your body fat percentage? If you don't know, just reply with "I don't know."

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Question 15 of 29

What do you do for a living? Are you active or sedentary at work?

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Question 16 of 29

What time do you wake up?

What time do you work?

What time do you work out?

What time do you sleep?

Paragraph answer

Question 17 of 29

What is your ideal meal breakdown? (meal times & number of meals)

Paragraph answer

Question 18 of 29

What is your current general diet? Be as specific as possible and include your macros if you know them.

Paragraph answer

Question 19 of 29

Anything you can't or won't eat? (dislikes or allergies)

Paragraph answer

Question 20 of 29

Any supplements or medications you're using?

Paragraph answer

Question 21 of 29

If you wear a FitBit, Apple Watch or other calorie tracking device, how many calories do you burn on average daily?

Paragraph answer

Your Training

Next we will cover some training details so I can design your nutrition around your training.

Question 23 of 29

Type of training you're doing now & frequency:

Include your rest days if you have a set schedule.

Paragraph answer

Emotional & Behavioral

Our thoughts & emotions directly influence our behaviors. Our behaviors play a major role in our adherence to a fitness and nutrition program.

Behavioral coaching is the third component to your program.

The next few questions will help us begin to identify any thoughts and emotions that may lead to behaviors that directly affect your success in this program.

Question 25 of 29

If you veer off course, are you more likely to:

A

Get back up & try again

B

Ask for help

C

Stay quiet & continue off course

Question 26 of 29

Can you identify any common limiting factors you find yourself experiencing that stop you from achieving your goals?

For example: no motivation, hate exercise, sweet tooth, eat junk at night, can’t contain yourself to one “cheat” meal, etc.

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Question 27 of 29

If you find yourself eating emotionally (you’re not actually hungry), can you identify your triggers?

For example: boredom, stressed, having an overall bad day, habit, etc.

Paragraph answer

Question 28 of 29

What coaching style do you respond to best?

(Select all that apply)

A

Tough love and constructive criticism

B

Empathy and understanding

C

Encourage strict adherence

D

Provide motivation without constructive criticism

E

I just want someone to listen

Question 29 of 29

Include any other details that you would like me to know.

Paragraph answer

Confirm and Submit

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All About You - Nutrition Intake Form

Click the button below to start.

First & Last Name:

Email address:

Phone Number

Instagram username (if applicable):

When is your ideal start date?

Progress Tracking

Upload your front view

Upload your back view

Upload your side view

Your Goals

What are your goals and why? Include: 1. Short term goals (2-4 weeks) 2. Medium term goals (1-12 months) 3. Long term goals (1-5+ years) Ask yourself why these goals are important to you and include your answer here too.

Your Stats

What is your age, height, weight?

What is your body fat percentage? If you don't know, just reply with "I don't know."

What do you do for a living? Are you active or sedentary at work?

What time do you wake up? What time do you work? What time do you work out? What time do you sleep?

What is your ideal meal breakdown? (meal times & number of meals)

What is your current general diet? Be as specific as possible and include your macros if you know them.

Anything you can't or won't eat? (dislikes or allergies)

Any supplements or medications you're using?

If you wear a FitBit, Apple Watch or other calorie tracking device, how many calories do you burn on average daily?

Your Training

Type of training you're doing now & frequency: Include your rest days if you have a set schedule.

Emotional & Behavioral

If you veer off course, are you more likely to:

Can you identify any common limiting factors you find yourself experiencing that stop you from achieving your goals? For example: no motivation, hate exercise, sweet tooth, eat junk at night, can’t contain yourself to one “cheat” meal, etc.

If you find yourself eating emotionally (you’re not actually hungry), can you identify your triggers? For example: boredom, stressed, having an overall bad day, habit, etc.

What coaching style do you respond to best?

Include any other details that you would like me to know.

Confirm and Submit

What are your goals and why?

Include:

1. Short term goals (2-4 weeks)

2. Medium term goals (1-12 months)

3. Long term goals (1-5+ years)

Ask yourself why these goals are important to you and include your answer here too.

What time do you wake up?

What time do you work?

What time do you work out?

What time do you sleep?

Type of training you're doing now & frequency:

Include your rest days if you have a set schedule.

Can you identify any common limiting factors you find yourself experiencing that stop you from achieving your goals?

For example: no motivation, hate exercise, sweet tooth, eat junk at night, can’t contain yourself to one “cheat” meal, etc.

If you find yourself eating emotionally (you’re not actually hungry), can you identify your triggers?

For example: boredom, stressed, having an overall bad day, habit, etc.