Personal Client Document (Jury) — Carson Laine Siler

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The following information is what I will use to create your custom plan. Please include as much detail as possible, and submit (with photos) at your convenience.

PERSONAL INFORMATION

Name

First Name

Last Name

Birthday

Best Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Instagram Account

Facebook Account

May I use your progress photos as a testimonial on social media (can be completely anonymous)?

Yes

HEALTH HISTORY

Age

Height

Current Weight

(if weight is unknown, provide measurements of chest, waist, hip and thigh)

Current Medications (RX)

Current Supplements

Known Medical Conditions

Have you been seen by your primary care physician within the last 12 months?

YES

Do you have a history of disordered eating or behavior around your weight, food, etc. ?

YES

PROGRESS PHOTOS

Your "before" photos are one of the most important parts of your journey and our work together. Documenting your starting point is not only an essential part of your program creation, but also a milestone to which we will refer often as you progress, transform and grow throughout our journey together. Progress Photo Requirements: Progress photos are mandatory and will be required in your weekly check ins facing the front, side and back. Take your (3) starting photos first thing in the morning using the best practices and tips below. Clothing: Photos should be taken wearing a bikini / two piece swimsuit whenever possible (a bra, sports bra and underwear can be worn as an alternative if needed). *It is BEST to wear the same outfit each week in your check ins, this is why a swimsuit is best! Location: Photos should be taken in well lit room, preferably near a window / natural lighting. Opt for a plain wall or space that is clutter free whenever possible. Avoid spaces like small bathrooms or hallways! Poses: Front photo- stand facing the camera in natural posture with arms by your side. Side photo- stand in natural posture with arms raised out in front of you (shoulder height). Back photo- stand in natural posture, feet shoulders width apart with arms by your side. Taking The Photos: The best way to capture photos (without a personal photographer/ helper) is to take a video of yourself using the front facing camera on your phone. For best results, take photos in a room with a countertop, table or object , table or object allowing you to rest/ prop your phone around waist height during the process. Open your camera and select the "video" setting. Start recording a new video using the front facing camera. This allows you to see yourself as you film, adjust as needed & modify your position to ensure until your entire body is visible at all times. Do NOT submit cropped or partial photos, I must be able to see you from head to toe! Stand in each position (front, side, back) for 5 seconds before moving on to the next. "End" the video once you've completed each position. To capture your images, simply review the video and pause it as needed to take screenshots and capture perfect images! PROGRESS PHOTO NO NO'S! Do NOT hold your phone in your check in photos. Do NOT wear shorts or garments covering parts of your body (legs, arms, stomach, etc.) that compromise my ability to fully access your physique, body composition and overall needs. Do NOT submit poorly lit, unclear photos- take pride in your journey and how you document it. Absolutely NO negative self talk, body shame or self loathing- you are beautiful, and a work in progress. MY RULE: If you wouldn't say it to ME, you are not allowed to say it to yourself!

NUTRITION QUESTIONNAIRE

Answer the following questions based off of your current habits and most recent behaviors around food (within the last 30 days).

Current food allergies or intolerances?

What is your current caloric intake (or most recent macro set)?

*If unknown, write N/A

Describe a "typical" day of eating with as much detail as possible (number of meals, fast food, specific foods, portion sizes if known, etc.)

Any other questions, concerns or things I need to know?

How many meals a day are you currently eating?

If you don't eat "meals," note how many times a day you eat / meal frequency

How many times per week do you dine out / order take out?

What is your average alcohol consumption? (Glasses per day, week, special occasions).

MOVEMENT & EXERCISE

Do you have an apple watch, FitBit, Garmin or activity tracking device?

Yes

Describe your activity level on an average day (week day, working, etc.)

If known, what is your current step average?

If you do not currently track your steps, describe an activity or form of exercise you've done recently (playing with kids counts)!

How many days a week are you currently working out?

How many cardio sessions are you doing per week (if any), and for how long (minutes)?

Describe your current workout routine, if applicable:

*Be specific with type of exercise, days per week, length of workouts, intensity, etc. Example: weight lifting 2 days per week for 45-60 minutes using free weights, 3 sets of 10 OR Yoga classes for 45 minutes 3 x per week and body weight home workouts (not very intense, 3/10)

LIFESTYLE

What are your favorite things to do on the weekends? What else do you enjoy?

Rank your average stress level on a scale of 1-5

Average sleep / night (hrs)

*include details if your sleep schedule is frequently compromised or varies

What are your current hobbies, passions, interests?

What does success look like to you?

Visualize yourself in the future...

Imagine that you have reached your goals and created an incredible transformation that you are proud of. You are strong, confident, empowered, beautiful and the best version of you.... Now, describe your future self. What do you look like? How do you feel? What kind of clothes are you wearing? What are you doing? Who are your friends? What makes you happy? What does it feel like to be you? *The more detail you are able to include ANYTIME you are manifesting a goal... the better!

Anything else that I should be aware of or that you think I should know before creating your plan?

Any questions for me? List them below!