New Client Intake Pt. 1 (Macros)

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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

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

After you click "SUBMIT" You will be taken to Part 2 of the Client intake form: The Physical Activity Readiness Questionnaire (PAR-Q)

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Amanda, the mastermind behind it all has devoted herself to providing weight loss programs and next-level fitness solutions to thousands.

P.O Box 64 Sisseton, SD 57262

support@farmfitmomma.com

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