One Off Nutrition Form LETS DO THIS BABES! Please enable JavaScript in your browser to complete this form. - Step 1 of 3Name *FirstLastEmail *Please double check this email is correctPhone *Date of Birth *Age *Height (cm) *Current Weight (kg) *EXERCISEProviding these details will allow us to prepare the best nutrition plan for you based on your current exercise levels.Is this your first time working with us? *YesNoHow did you find out about this program? *A referral by friend or family memberSocial mediaOtherExercise experience level *Just Starting NowModerate - have follow a program beforeAdvancedHow often do you train? *Just Starting Now2-4 times a weekEverydayWhat do you hope to achieve from this program? *Fat lossMuscle gainOverall health and better eating habitsYou can only select ONE option as this will determine how we develop your training and nutrition plans (you can elaborate below)What are your short term training goals? *What are your long term training goals? *Please tell us about your past training experience? *How many days per week CAN your do weight training and how long for? *How many days per week CAN your do cardio training and how long for? *Do you feel faint or dizzy when exercising? *Are you on any prescribed medications? Please list them below *Do you currently undergo any type of fitness training? If so how often? (Choose one) *I currently don’t trainYes I train 1-2x per weekYes I train 3-5x per weekYes I train 6+ x per weekWhat type of training are you currently doing and how often/long ? (Be specific EG- Running 2x 30 mins, Yoga 1x , Weights 3x) *What is your current daily activity levels? Choose One: *Sedentary (Office job) Less than 5000 steps per dayModerately Active (Teacher, retails etc 5000-8000 Steps per day )Active (Hospitality, manual labour etc 8000-10000 steps per day.Very Active 12000 + Steps per dayNextNUTRITIONThe more information you can give us the better it is for us to be able to create the best nutrition plan for your goals and needs.Do you have any food allergies or dietary requirements? *Are you currently taking any vitamins or supplements? *How easy is it for you to follow a nutrition plan? Scale of 1-10 ; 10 being easy *Have you followed a nutrition plan before? If so please list your dieting history, nutritionist and if this was successful for you? *Are there any foods you dislike or don’t want in your nutrition plan? *The more information the better so that we can create the best plan for you.Are there any foods you love or want to see included in your nutrition plan? Note- We will do our best to try and include some of these. *The more information the better so that we can create the best plan for you.What do you do for a job? Eg: Shift work, 9-5 job, travel all day. Please be specific. *How many times per day do you prefer to eat? Eg; 3-4 larger meals or 5-6 smaller meals. *CURRENT DIETWe want you to achieve the best results possible, so to customise the best nutrition plan for you it is important to know your current eating habits. BREAKFASTWhat is your current go-to breakfast and what time do you eat this? *If you could choose 3 breakfast options on your plan what would they be? *EG- Oats with peaches, cocoa pops with banana, eggs on toast, loaded protein shake etcSNACKSWhat is your go-to morning snack and what time do you eat this? *If you could choose 4 snack foods what would they be? *EG- Eggs on toast, specific protein bar you enjoy, corn thins with ham and hummus, fruit and nutsLUNCHWhat is your typical lunch and what time do you eat this? *Please add portion sizes AFTERNOON SNACKWhat is your go-to afternoon snack and what time do you eat this? *DINNERWhat is your typical dinner and what time do you eat this? *Please add portion sizesDo you eat anything after dinner and what time do you eat this? *Please explain your weekend diet with portion sizes and times *Please be specificNextCHOOSE 3 From each box so we know what type of foods you enjoyFruit *BananaAppleOrangePeachBerriesOther- FruitPlease list any other choices you enjoyFat Sources *AvocadoCheeseFetaOlive oilRaw NutsNut ButterOther- FatsPlease list any other choices you enjoyProtein SourcesChickenBeefFishPrawnsLentilsProtein + YoghurtOther- ProteinPlease list any other choices you enjoyCarb Sources *Sweet PotatoPumpkinRiceBreadWrapsPastaOther- CarbsPlease list any other choices you enjoyIs there anything else we need to know that may affect your Nutrition plan? Be specific Eg- Pregnant, health concerns, injuries or recent surgeries. *What could potentially stop you from achieving your health and fitness goals with Jess Coate Fitness? *Out of 10 how much do you want to achieve your goals? *10/10: I am ALL IN6-9: My goals are important to me5: I feel I have tooI understand I should get full doctors clearance before starting my Nutrition plan with Jess Coate Fitness. *YesI understand my turn around time for my plan is 5 working days *YesFile Upload Click or drag files to this area to upload. You can upload up to 5 files. Lastly if you would like to submit front side and back photos along with this info. These photos showcase a better starting point and great tool for us to design the best plans to suit your goals.Sign up now
