Welcome to Nutritional Coaching!

STEP ONE - Complete Payment & Submit Contract

Please click the link below to submit payment. You payment will pull on the same date of every month as the payment that was initially made. (Example - If you pay on the fourth of July, your next payment will pull on the fourth of August)

STEP TWO - Let’s get to know YOU!

Please complete the intake form below.

Name

First Name

Last Name

Age

Gender

Occupation

Current Weight

Height

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Instagram

How did you hear about Reese Fitness?

What are the main goals that you'd like to achieve while working with me?

(Please list no more than three and list at least on non phsyique/scale focus goal) Example: “ I would like to lose 15 lbs, have more muscle definition and be able to do 1 unassisted pull up “

What is your “why”? What is motivation you to want to make this change in your life ?

What do you feel your major weakness is when it comes to working out?

What do you feel your major strength is when it comes to working out?

Past injuries or surgeries that affect mobility?

How often do you currently workout?

(Minutes per day/ Days per week)

What kind of workouts do you typically perform and where do you usually workout?

What is your work schedule? And does it interfere with your nutrition, training or sleep schedule?

Roughly how many hours do you sleep a night?

Roughly how much water do you drink a day?

How are active are you in your daily life?

(Barely Active 1 – Very Active 5)

Do you know how many steps you take a day ? If so, please list your daily average steps below.

On a scale of 1 to 10, how would you rate your daily stress level?

How many days a week do you think you can consistently strength training? (Remember that more isn’t always better, it’s about what you can maintain and stay consistent with.) Also, what days would you prefer to train and what days would you prefer to have as a rest day?

Are you currently or have you ever been pregnant?

If yes, how many children so you currently have, what type of birth did you have for each (C-section / Vaginal Birth), did you experience “Diastasis recti” during any of your pregnancies and are you currently breastfeeding ?

Anything you’d like to add or share with me that you think would be helpful for me to know?

Welcome to Nutritional Coaching!

STEP ONE - Complete Payment & Submit Contract

STEP TWO - Let’s get to know YOU!

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