Nutrition assessment Name * First Name Last Name Email * Phone (###) ### #### Age Weight (in lbs) Height (in Inches) * Please describe your goal using the SMART model * (specific, measurable, achievable, relevant, time-bound) * Why Is This Goal Important To You? * How Does Obtaining Your Goal Affect You/Others Around You? Food Preferences Food Preference (if any) * How Many Times a Day Do You eat? * Describe Your Typical Pattern of Eating Describe Your Relationship with food. * Lifestyle & Exercise * How Many Days a Week do you Workout? * Describe Your Job. * Have You Tracked Your food intake before? Yes No * What App Did You Use? * Do you track your steps (via apple watch, fitbit, etc...) If yes how many average steps per day? * Describe your workouts (current or past). * Describe Your Experience with Tracking macros. * What supplements/medicines are you currently taking? * How many hours of sleep do you get? * What are your primary daily stressors? * What do you do to relieve stress? * How are your energy levels day to day? * Is there any medical or psychological reasons why you shouldn't start a nutritional intervention program at this time? Coaching Styles * How Restrictive Do You want to be? * How Do You Want to be Coached? * What is the best thing to say to you if you need to be held accountable or want to quit on yourself? Thank you!
