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Matthew Sechoka

Summit Strength Training LLC

Acknowledgment and Assumption of Risk

By signing and initialing at the end of this waiver, I acknowledge that I have voluntarily chosen to participate in macro based nutrition coaching provided by Matthew Sechoka and Summit Strength Training LLC. 

I understand and agree that:


 1. Summit Strength Training is not a licensed medical provider and does not provide medical advice, diagnoses, or treatment.


 2.  Nutrition coaching is not a substitute for medical care from a licensed physician, registered dietitian, or other healthcare professional.


 3.  I understand that it is my responsibility to consult a healthcare provider before making any significant dietary or lifestyle changes, especially if I have a medical condition, food allergies, or am taking medications.


 4.  I acknowledge that all recommendations provided by Summit Strength Training are for educational purposes only and are based on the information I voluntarily provide.


 5.  I understand that all results from nutrition coaching are individual and not guaranteed.


 6.  I knowingly and voluntarily assume all risk of injury, illness, or adverse effects that may result from following the advice, suggestions, or information provided to me.


 7. Results may vary: Individual outcomes depend on numerous factors including age, genetics, lifestyle, medical history, and adherence to recommendations. No guarantees of specific results are made or implied. 


8. Commitment to Program Duration:

I acknowledge and understand that meaningful and sustainable changes in nutrition and lifestyle habits require time, consistency, and active participation. In recognition of this, I agree to commit to a minimum period of three (3) consecutive months of nutrition coaching services with Summit Strength Training LLC. I understand that this duration is intended to allow for the development, implementation, and refinement of personalized strategies to support my health and performance goals. I further agree to actively engage in the program throughout this period, including adhering to outlined nutrition recommendations to the best of my ability, and maintaining open communication with my coach. I recognize that early termination of this agreement may limit my ability to achieve optimal results. The Client acknowledges and agrees that additional payments may be required to maintain or extend participation in the program. All fees paid are strictly non-refundable and non-transferable, regardless of the level or duration of participation. In the event that the Client requests early termination of services, additional fees may be incurred in accordance with program policies.


 9.  I hereby release, waive, and hold harmless Summit Strength Training LLC and Matt Sechoka from any and all liability, claims, demands, actions, or causes of action whatsoever arising out of or related to any loss, damage, or injury that may be sustained by me as a result of participation in nutrition coaching.

Acknowledgment & Agreement

By initialing and digitally signing below, using your full name, I acknowledge and accept the above terms.



First Client's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
First Client's Date of Birth*
Date of Birth
First Client's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
First Client's Signature*
Second Client's Name
First Name*
Middle Name
Last Name*
Select Gender
Client's Date of Birth*
Date of Birth
Second Client's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
Second Client's Signature*
Third Client's Name
First Name*
Middle Name
Last Name*
Select Gender
Client's Date of Birth*
Date of Birth
Third Client's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
Third Client's Signature*
Fourth Client's Name
First Name*
Middle Name
Last Name*
Select Gender
Client's Date of Birth*
Date of Birth
Fourth Client's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
Fourth Client's Signature*
Fifth Client's Name
First Name*
Middle Name
Last Name*
Select Gender
Client's Date of Birth*
Date of Birth
Fifth Client's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
Fifth Client's Signature*
Sixth Client's Name
First Name*
Middle Name
Last Name*
Select Gender
Client's Date of Birth*
Date of Birth
Sixth Client's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
Sixth Client's Signature*
Seventh Client's Name
First Name*
Middle Name
Last Name*
Select Gender
Client's Date of Birth*
Date of Birth
Seventh Client's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
Seventh Client's Signature*
Eighth Client's Name
First Name*
Middle Name
Last Name*
Select Gender
Client's Date of Birth*
Date of Birth
Eighth Client's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
Eighth Client's Signature*
Ninth Client's Name
First Name*
Middle Name
Last Name*
Select Gender
Client's Date of Birth*
Date of Birth
Ninth Client's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
Ninth Client's Signature*
Tenth Client's Name
First Name*
Middle Name
Last Name*
Select Gender
Client's Date of Birth*
Date of Birth
Tenth Client's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
Tenth Client's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Relationship*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
What is your height in feet?
What is your current weight in pounds?
What is your activity level?
Very Light: Sitting most of the day (example: desk job).
Light: A mix of sitting, standing, and light activity (example: teacher).
Moderate: Continuous gentle to moderate activity (example: restaurant server).
Heavy: Strenuous activity throughout the day (example: construction work).
How often do you exercise and what type of training do you do?
What best describes your weekly workouts?
Very Light: Almost no purposeful exercise.
Light: 1-3 hours of gentle to moderate exercise.
Moderate: 3-4 hours of moderate exercise.
Intense: 4-6 hours of moderate to strenuous exercise.
Very Intense: 7+ hours of strenuous exercise.
This will be a macro based approach with sample meals and a list of foods to choose from. Will that work for you? Yes or no.
As a macro based approach, tracking meals and macro nutrients will be critical to success. Are you willing to take on the responsibility of doing that? Yes or no.
What are your goals in order so we can tackle them one at a time? Examples are: Lose weight, gain muscle, athletic performance, body recomposition (gain muscle while lose body-fat), Improve health.
What is your preferred style of eating? Examples are: Anything (No major preferences or restrictions. Will eat practically anything.), Mediterranean, Paleo, Ketogenic, etc.
What are some of your favorite foods or meals?
Are there any foods you dislike or refuse to eat?
How many meals do you eat per day? What do those meals typically look like?
Do you snack between meals? If so, how often and what do you usually eat?
On a scale of 1–10, how committed are you to reaching your nutrition goals?
What motivates you to pursue your nutrition goals?
What obstacles have prevented you from reaching your goals in the past?
How do you usually get your meals? Examples: Cook or prepare yourself, eat out frequently, meal prep service.
What foods or drinks do you consume daily or very frequently?
Do you have any diagnosed medical conditions? Yes or no. IF yes, please explain in detail.
List any medications or supplements you’re currently taking:
Do you have any food allergies, intolerances, or sensitivities? If yes, please explain.
Do you regularly experience any of the following:
Bloating
Fatigue
Constipation
Diarrhea
Heartburn
Mood Swings
Trouble Sleeping
Brain Fog
Cravings (Sugar, Salt, Caffeine)
None of the above
Describe a typical day of eating from wake-up to bedtime:
How many hours of sleep do you get on average per night?
Rate your average stress level (1 low–5 high). If high, why are you stressed?
Is there anything else I should know to help you succeed?
Parent or Guardian's Signature*
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