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First Name
Last Name
Email
Confirm e-mail
City
State
Zip Code
Height (feet)
4'
5'
6'
Height (inches)
0"
1"
2"
3"
4"
5"
6"
7"
8"
9"
10"
11"
Weight (lbs)
Age
Gender
Male
Female
Describe your fitness goals.
Slim down my waist
Get abs
Look good in a bikini
Get back to pre-pregnancy weight/physique
Prepare for a specific event
Try a new fitness routine
Compete in a race (e.g., 10K, half-marathon)
Incorporate fitness into a busy lifestyle
Prep for a fitness challenge or competition
Enhance overall well-being
Other Fitness Goals (optional)
Which of the following diets (if any) have you tried before?
Mediterranean
Ketogenic (Keto)
Paleo
Intermittent Fasting
Atkins
Weight Watchers
Plant-Based
Vegan
DASH (Dietary Approaches to Stop Hypertension)
Zone, Whole30
South Beach
Raw Food
Low-Carb
Carnivore
None
Other
Please list any dietary restrictions or food allergies.
Fish
Eggs
Shellfish
Dairy
Soy
Gluten
Tree Nuts
Peanuts
Do you have any dietary preferences?
Vegan
Vegetarian (Eggs Ok)
Vegetarian (Dairy Ok)
Vegetarian (Eggs & Dairy Ok)
Pescatarian
Paleo
No Preference
Please List any additional food allergies or preferences. (optional)
Are you currently taking any prescribed medications?
Yes
No
Have you ever been diagnosed or treated for diabetes?
Yes
No
Are you familiar with tracking macros?
Yes
No
Are you currently taking any supplements?
Yes
No
Do you have any physical limitations or injuries?
Yes
No
If Yes, please indicate any limitations, injuries or conditions
How often do you exercise?
1 day/week
2 - 3 days/week
4 - 5 days/week
6 - 7 days/week
What does your current exercise routine include? (Check all that apply)
Cardio
Cycling
Long-distance running
Rowing
Weight Lifting
Circuit Training
Aerobics
Swimming
Yoga
Pilates
Other
None
How did you hear about us?
Facebook
YouTube
Instagram
Website
Referral
Other
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