Email* Name* First Last Phone*Age*Weight*Gender*FemaleMaleHeight*Please explain the reason that you want to work with a coach.*What are your overall nutrition goals?*Previous dieting history and current diet (other diets you’ve followed, current eating habits, biggest struggles etc.)*On a scale of 1-5 how compliant were you when following other programs/diets? (1 meaning not compliant at all 5 meaning 100% compliant)*1 (Not Compliant)2345 (100% Compliant)How much alcohol do you consume per week?*Do you Smoke?*YesNoWhat and how much per day?Has your body weight or body composition made any drastic changes over the past 12 months? If so, please explain.*YesNoPlease Explain*Has there been any drastic changes to your diet recently?*Do you take any supplements? Please list them.Do you take any medications? Please list what you take.*Do you have regular bowel movements. Regular meaning daily and easy. Please explain.*What are you expecting to learn from your coaching experience?*Questions Below Are For Women OnlyDo you have a regular period cycle?*Are you pregnant or nursing?*Are you pre-menopausal or in menopause?*TrainingTell us about your current training (frequency, volume, intensity, what kind of training etc.)*How long do you typically exercise for in one session?*Please describe your current workout routine.*What is your activity level outside the gym?Please select your Coach*Select OneDana Black