Name *

First Name

Last Name

Phone

(###)

###

####

Best Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Biological Sex

Male

Female

What's Your TOP Goal?

You may want to do more than one, but choose the one most important to you!

LOSE WEIGHT - want to lose at least 10-15 lbs or more

BUILD MUSCLE - wants to build muscle and increase overall body weight

ATHLETIC PERFORMANCE - wants optimal nutrition to support long and intense athletic training (minimal to no weight change desired)

BODY RECOMPOSITION - wants to lose less than 10-15 lbs of body fat, while simultaneously building muscle

IMPROVE HEALTH - wants to improve their nutrition and overall health, while maintaining current weight

What's Your Preferred Eating Style

Anything - No major preferences or restrictions. Will eat anything

Mediterranean - Features plant foods, healthy fats, and moderate amounts of lean proteins

Paleo - Emphasizes meats, vegetables, and healthy fats

Vegetarian - A plant-based diet, plus small amounts of eggs and diary

Ketogenic - a high fat, very low carbohydrate diet

How Many Meals a Day Do You Prefer to Eat

1-2 meals

3-4 meals

5-6 meals

7-8 meals

Describe How Active You Are (Excluding Exercise)

Very Light (example: desk job)

Light - a mix of standing, sitting, and light activity (example: teacher)

Moderate - Continuous gentle to moderate activity (example: restaurant server)

Heavy - Strenuous activity throughout the day (example: construction worker)

What Best Describes Your Weekly Workouts?

If you are between choices, choose the 'lighter' choice.

Very Light - Almost no purposeful exercise

Light - 1-3 hours of gentle to moderate exercise

Moderate - 3-4 hours of moderate exercise

Intense - 4-6 hours of moderate to strenuous exercise

Very Intense - 7+ hours of strenuous exercise