Keto Better Life & Goddess Gains // Q&A Form
By Genevieve 'Keto Goddess' Castonguay
Name:
*
E-mail
*
Age
Height
Current Weight
Body Fat %
If known
Goal Weight OR BF%
If applicable
Keto Duration
0-3 months
3-6 months
6-12 months
1 year +
NA
Primary Body Composition Goal
Lose Weight/Reduce Fat (Over 30lbs)
Lose Weight/Reduce Fat (10-30lbs)
Reduce Fat/Lean Muscle Mass (10 lbs variance)
Maintain Weight (0-5lbs)
Gain Muscle Mass (+5-15lbs)
Gain Muscle Mass (+15lbs or more)
Which of the following are important to you?
*
Fat Reduction & Weight Loss
Energy & Endurance
Building Lean Muscle Mass
Healthier Digestive System
Vitality, Longevity & Positive Outlook
Rid the body of Bad Carb & Sugar Cravings
All of the above
Employment Activity Level
*
Sedentary (Desk Job/Seated)
Moderate (Standing, Walking Involved)
Active (Mostly on feet or active)
Intensive (Higher than average movement/mobility every day)
Exercise Level
*
Sedentary (No schedule exercise beyond daily activities)
Moderate (Light-Moderate Exercise 1-3x week for min 30 minutes)
Active (Moderate Exercise 3-5x for 30 minutes)
Intensive (5x or more per week at Moderate to Intense exertion)
Where do you exercise (primarily)?
NA - No formal exercise
At-Home
Gym or Classes
Outdoors
Please list access to equipment:
i.e. freeweights, bodyweight only, resistance bands, Bowflex, etc
How Many Calories Do You Currently Consume Per Day?
On Average
How Many Litres of Water Do You Consume Per Day?
On Average
Do you practice intermittent fasting?
If yes, type the typical model (i.e. 16:8, 24 every week, etc)
Do you have any health issues/concerns that impact your diet?
i.e. IBS, gallbladder, fatty liver, diabetes, etc
Do you have any health issues/concerns that impact your physical health?
i.e. surgery, injury, mobility issues
Do you abstain from any types of food (i.e. dairy, fish, pork, nuts)?
On a typical day, which of these macronutrient profiles would you say you follow currently? (Percentages of Fat/Protein/Carbs)
75/20/5 (or higher in fat)
70/20/10
60/30/10
50/25/25
It varies or I'm unsure
Which coaching option are you interested in learning more about?
Ketogenic Lifestyle Coaching ONLY
Fitness Training Remote or In-Person ONLY
Remote: Food & Fitness
In-Person: Food & Fitness Coaching & Training
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