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JDFiT-Nutritional Coaching
Application for Nutritional Coaching w/ JanelleDFiT
Name
First
Last
Email
Phone
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Height
Weight
Birthday
Age
Do you have high blood pressure? If so, please detail medications (if any)
Have you attempted diets in the past? If so; which ones:
Current Occupation
Do you sit during most of your day?
How often do you workout today (days/week) and for how long (duration per session)?
Do you have a specific timeframe for achieving your goals? If so, please explain:
Please provide measurements in inches on the following:
Neck
Chest
Left Bicep
Right Bicep
Waist
Hips
Left Thigh
Right Thigh
Left Calf
Right Calf
What do you feel is your biggest struggle when it comes to nutrition specifically?
Are you committed to tracking your calories daily?
How would you explain your relationship with food? How do you feel about food in general?
Please provide at least 3 days and times that you are available to have an assessment call.
Please provide any additional detail that will be helpful to know about your nutrition such as: 1.) any supplements you take 2.) how often you go out to eat or order take out 3.) if you meal prep, how are you doing it today, and 4.) any food allergies or restrictions:
Are you ready to get started right away?
Yes
No
Within 2 weeks
