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New Client intake (Macros) Pt.1
First name
Last name
Email Address (will be a priority form of contact for application process)
Date of Birth (Month)
Date of Birth (Day)
Date of Birth (Year)
Weight
Height
Age
Gender
Anything we need to be aware of as far as nutrition goes?
Are you pregnant or breastfeeding?
Yes
No
Please list out a 6-week goal for 1) Strength 2) Endurance, 3) Physical Health, 4) Mental/Emotional Health
How active are you at your job? (Keep in mind, that although I work out at least 5 days a week with 2-3 days of Cardio, I am considered Lightly Active)
1 (Sedentary: Desk Job, sitting a lot)
2 (Lightly Active: 1-3 days/wk)
3 (Moderately Active: 4-5 days/Active Lifestyle or Training for Event)
4 (Very Active: Training hard for Sport/Purpose)
5 (Moving Non-stop)
What is your primary goal?
Fat Loss
Muscle Gain
Maintenance
Submit
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