Submit Your InformationAfter reviewing your information, we will design a plan specific to your goals, lifestyle, and history. Name * First Name Last Name Age * Weight * enter number in lbs Height * Email * How did you hear about us? If you were referred by someone, enter their name here: What are your physique goals? * What obstacles do you think you may have when it comes to changing your body? * I don’t think I can stick to a plan My life is too stressful/busy I don’t know how to follow a nutrition plan and/or prepfood Diets have not worked for me in the past even when I follow the plan Social eating/drinking will get in the way Other (Please specify below) If "Other" to above, please describe Which category would you consider yourself to be when it comes to lifting weights: * I’ve never lifted in my life I’ve taken group exercise classes and some of these include a weight segment I have used lighter weights and machines but am not comfortable lifting heavy or using a lot of free weights I have worked with a personal trainer or done Crossfit and am comfortable squatting, deadlifting, bench pressing, and shoulder pressing Do you have any injuries we need to be aware of? Describe in detail what you are doing currently in terms of workouts. Please be as detailed as possible and list how many days/minutes per week you are doing cardio, weight lifting, other exercise, etc. * Realistically, how much time each week/day could you dedicate to working out? Don’t over commit yourself if you don’t think you will truly be able to make the time. * What sort of workout facility do you have access to? If you aren’t a gym member, please be specific about the type of equipment you have access to. * How many times have you attempted to lose weight? * Have you attempted to lose weight or cut calories in the past 6 months? * Yes No Describe your previous history trying to lose weight (if any). Be as detailed as possible (ex. two years ago lost 10lbs doing weight watchers but gained it all back, lost 5lbs on my own but want to lose another 5 more) * Do you have any known thyroid, insulin, or hormonal issues? Please describe and list any medications you are currently taking. How many calories do you typically eat in a day? less than 1200 1200-1400 1400-1600 1700-2000 2000-2500 2500+ No Idea How long have you been eating at this calorie level? In the past 6 months, have you eaten a specific diet plan (ex. Keto, paleo, etc.)? Please describe what that was and how long you have been eating that way. * If we determine that you have actually been under-eating (and therefore, have a suppressed metabolism, are you open to increasing your calories in order to restore your metabolic health prior to embarking on a fat-loss journey? Yes No THIS LAST PORTION IS OPTIONAL BUT THE MORE INFORMATION YOU PROVIDE, THE MORE ACCURATELY WE CAN ASSESS YOUR METABOLIC HEALTH. The questions below will require that you enter two days of eating into myfitnesspal that are typical of what you would normally eat. DO NOT try to make it look healthier than your typical eating. This is very important and what we will base your starting macros from. One of the days should be a typical day of weekday eating and the other should be a typical day of weekend eating. Track everything, including alcohol, the oil you use to cook your food in, etc. The protein/carb/fat/calorie numbers from this should be used to populate the final section of this application. Enter your typical weekday macros here: Calories, Protein, Carbs, Fat (in grams) Enter your typical weekend macros here: Calories, Protein, Carbs, Fat (in grams) Alternatively, if you do not want to track your macros, please enter a sample "day of eating" here. Please do not try to make this look "healtheir" than a typical day! This is very important to us as we design your customized plan. Thank you! Thanks for submitting your information. Expect to hear back from one of our coaches soon.
