Example Nutrition Client Application

Nutrition Coaching Application

Please complete the form below as it is sent directly to your coach for review, providing a better understanding of your goals and what's holding you back from them. Once the completed information is received, your coach will be in touch within 24 hours to review your application.

Name

Best Phone Number:

Age

Height (Feet, Inches)

Current Body Weight (Lbs)

As briefly as possible, what are your health and fitness goals (i.e. lose X amount of weight, improve energy and vitality, guidance for a specific event, sports performance):

What do you feel your current nutrition and health plan is lacking or holding you back from reaching this goal?

On a scale of 1-10 (10 being EXTREMELY), how ready are you to change your lifestyle?

Do you have any medical conditions, injuries or health concerns?

Are you currently taking any medications or supplements?

Please explain your current fitness, exercise or training schedule

Describe your support system you have/don't have at home, work or your community

Explain your past history with dieting and/or how familiar you are with tracking your food/macros/calories

How did you hear about me? (social media, referral etc)

Anything else I should know?

*Assessment and coaching services provided by Nutrition Coach re intended for educational and informational purposes only and not intended to be medical advice. Speak to your doctor before starting this program or making any changes to your diet or exercise routine. *I acknowledge, understand and agree to the above*

Example Nutrition Client Application

Nutrition Coaching Application

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