EmailMe Form - Over 40 Nutrition Information Sheet

Are YOU ready to COMMIT 100%, NO Excuses, NO BS *

YES

NO

Name *

First Last

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Date Time *

MM / DD / YYYY

Current Weight *

Bodyfat % (if known)

Height *

Age *

Actvity

	Exercise Type	Times Per Week	Duration	Intensity
#1
#2
#3
#4

Lifestyle & Goals *

Describe Goals *

Weightloss

Maintain

Gain Muscle

Sports Specific

Eating Style or Preference *

Explain Other Preference Above

Goal Weight *

What time do you wake up? *

What time do you go to bed? *

Do you drink alcohol (how many and describe)? *

Food Allergies (yes/no and explain if yes)? *

Food Choices: Likes & Loves *

Food Choices: Hates & Can't Eat! *

Food Choices: MUST HAVES! *

Additional Notes for Your Coach

IMAGE UPLOAD

These are a MUST for any coaching program.

***Please take pics in a well lit area with a solid light or white background (no busy backgrounds). Same place, same time of day, same day each week, same outfit if possible. Position the camera in front of you, no weird angles. Use a tripod if you have or setup phone appropriately.

Guys: Boxers, briefs, etc..
Ladies: Whatever you feel comfortable in. Bikinis, sports bra and tight shorts.

These pics are meant to show detail of your body to help evaluate progress and losses in specific areas. The more revealing the better we can judge progress and flaws that need to be addressed.

FRONT VIEW

LEFT SIDE

RIGHT SIDE

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