1. Your Name (required)

2. Your Email (required)

3. Current Height

4. Current Weight

5. Current Age

6. Optimal Weight

7. If this plan was perfect and helped you accomplish all your nutrition goals, what specifically would it include to help you out most?

8. What do you need most help with when it comes to nutrition? What are your goals?

9. Do you have a rough idea of how many calories you currently take in? If so, how many?

10. Do you tend to eat more carbs than protein? Sweet tooth?

11. How many meals a day do you eat?

12. Do you cook the meals for yourself or a family?

13. If you have a job, what kind of job do you work? Office, outdoors, at home? Is it a typical 9-5 job with a 1 hour lunch?

14. Do you have access to a fridge, microwave at work?

15. Do you have any food allergies?

16. Are there any foods that you will absolutely not eat?

1-2 Day Food Journal

Please provide a 1-2 day food diary of a typical day of eating for you. This would include everything you eat including quantities and time of day you eat them. This gives me a better understanding of where you currently are with nutrition.