Client Intake Form

Macro Missionary

Fill this our completely and honestly so we can formulate your plan

Name*

Enter your first and last name

Email*

Please, enter your email

Phone Number*

How did you hear about Macro Missionary?*

Age*

Weight (in lbs)*

Enter Your Morning Weight

Body Fat % (if known)

Height in Inches*

Resting Heart Rate?*

Please describe your goal using the SMART model

(specific, measurable, achievable, relevant, time-bound)

Please give as much details as possible.*

Why Is This Goal Important To You?*

How Does Obtaining Your Goal Affect You/Others Around You?

Include dedications, who will benefit once achieved, how things will change once achieved

Obtaining Your Goal

Food Preferences

Check all that apply

Food Preference (if any)*

How Many Times a Day do You eat?*

Describe Your Typical Pattern of Eating*

Please list the foods/drinks you've consumed in the past 3-7 days *include at least one weekend day*

Describe Your Relationship with food including any past eating disorders*

Lifestyle & Exercise

How Many Days a Week do you Workout?

Describe Your Job*

Have You Tracked Your food intake before?*

What App Did You Use?*

Do you track your steps (via fit bit etc) If yes how many average steps per day?*

Describe your workouts.*

Tell us weights, cardio, how many times per week

Describe Your Experience with Tracking macros*

What supplements/medicines are you currently taking?*

How many hours of sleep do you get?*

What are your primary daily stressors?

What do you do to relieve stress?

How are your energy levels day to day?

Is there any medical or psychological reasons why you shouldn't start a nutritional intervention program at this time?*

Coaching Styles

How Restrictive Do You want to be? (select 1)*

How Do You Want to be Coached?*

Choose Your Coach*

What is the best thing to say to you if you need to be held accountable or want to quit on yourself?*

Upload Your Starting Photos Here*

Front/Back/Side if possible

Max. file size: 50 MB.

Email

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