Goals Questionnaire & Nutrition Consultation
Welcome, please complete this entire form so that we can be best prepared to guide you. Sharing your goals allows us to make appropriate recommendations to best serve you! I look forward to helping you. Kerri
Name:
Email:
The goals I would like to focus most on are:
WEIGHT LOSS
TONING & SCULPTING
BUILDING LEAN MUSCLE
DETOX/CLEANSING
OVERALL HEALTH & WELLNESS
PERFORMANCE & RECOVERY
Other
Check all that apply:
I EXERCISE REGULARLY
I DO NOT EXERCISE REGULARLY
Check all that apply:
I TYPICALLY DO NOT EAT BREAKFAST
I EAT 5 TO 6 MEALS A DAY
I TYPICALLY UNDEREAT
I TYPICALLY OVEREAT
What do you currently use to boost your energy?:
SODA
COFFEE
ENERGY DRINKS
NOTHING
Check all that apply:
I take nutritional supplements
I do not take nutritional supplements
How many ounces of water do you consume daily?:
20 oz
30-40oz
50-60oz
70-80oz
Other
Please share anything you feel would help us serve you better!
Height:
Weight:
Age:
Please Select
18-24
25-34
35-39
40-45
46-50
51 or older
Submit
Should be Empty: