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About
Meal Plan
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Group Coaching
Nutritional Therapy
Macros
Recipes
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NutriWise Health Store
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One-time Fee
/ One-Time Custom Macro Count
One-Time Custom Macro Count
$
129.00
Step
1
of
2
50%
Name
Date
MM slash DD slash YYYY
Welcome to NutriWise, the ultimate high-vibe, badass coaching program designed for dedicated women ready to transform their lives. If you're tirelessly working towards your goals but feel like you're just shy of nailing it, you're in the right place. NutriWise will help you seamlessly integrate good habits into your life, elevate your health, and savor every meal without guilt. Stop wondering what could be and start living your most vibrant life today. Let’s explore if NutriWise is the perfect fit for your one-on-one transformation journey.
Age
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Weight
Pounds
Kilograms
Stones
Enter Weight
(Required)
Height
(Required)
Feet & Inches
Centimeters
Select Height
(Required)
Goals (check all that apply)
Muscle Building
Weight Loss and/Fat Loss
Strength Building
Healthy Food Habits
Lifestyle Change
What are your wellness goals for the next 3-6 months? Why are these goals important to you? Be very specific, the more detail the better!
(Required)
Do you have any injuries (past and present) or surgeries/health conditions to note (i.e. PCOS, gastric bypass, hysterectomy, hypothyroidism, HRT, IBS, etc.)
(Required)
Current workout routine & nutrition (food types, # of meals per day cardio, lifting....and how many days/minutes per week?
(Required)
What past diets have you done? When was your last diet?
(Required)
Have you counted macros or calories before? If so, how many calories are you eating right now?
(Required)
Why do you want to work with me?
(Required)
What is your biggest hurdle in getting to your goals AND why do you want to make a change now?
(Required)
High level coaching requires an investment that starts at a few hundred dollars per month and I want us to be YES to work together - financially, physically and emotionally. Are you ready to invest in yourself?
YES
NO
I will figure out how to make this work
What are your goals for the next 3-6 months?
(Required)
Are you currently on hormonal birth control, if so how long?
(Required)
Important for Metabolism.
Are you on any current medications?
(Required)
Have you ever been diagnosed with a metabolic disorder such as PCOS, hypothyroidism, hyperthyroidism, etc.?
(Required)
Any health conditions (including weight loss surgery and hormone imbalances)?How much has your weight changed in the past 12 months?
(Required)
How many hours a day do you sit?
(Required)
How many steps are you getting per day?
(Required)
How many days of lifting per week? How long are the sessions?
How many minutes & days of cardio do you do per week? What kind of cardio/classes are you doing?
(Required)
Are you taking any rest days?
(Required)
Do you have any physical limitations or injuries I should know about?
(Required)
Do you have a physically demanding job? Do you take long dog-walks frequently?
(Required)
Do you workout at home, gym or both?
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If working out at home-what DB's do you have? (I highly recommend a few lighter DB's such as 8, 10, 15's for upper body and at least one pair of heavier DB'S like 20 or 30lbs for lower body workouts. 8-15 lbs is not sufficient for optimal lower body
(Required)
How many calories/macros are you eating per day?
(Required)
How much time have you eaten the calories or macros above?
(Required)
How many steps do you take per day?
(Required)
How many meals are you eating per day?
(Required)
Please describe two-three entire days worth of meals you have had over the last 7 days (try to include one weekday and one weekend day; not when you're trying to diet but where you are at currently this week) so I can get a clear picture.
(Required)
What protein sources do you like to eat? Are you a vegan or vegetarian?
(Required)
How many ounces of water do you think you drink a day?
(Required)
Do you drink caffeine, flavored water, tea or soda? If yes, how many ounces per day?
(Required)
Do you drink alcohol? If so, how much and how often?
(Required)
What supplements do you use on a regular basis?
(Required)
Is your digestion regular/irregular? Experiencing any persistent abnormal bloating, constipation, GI discomfort?
(Required)
Is your digestion regular/irregular? Experiencing any persistent abnormal bloating, constipation, GI discomfort?
(Required)
Have you recently done any diets? When and how long? Describe them.
(Required)
Please detail your weekday and weekend schedule (please let us know if you do shift work).
(Required)
Do you travel work, please let us know duration and frequency.
(Required)
How many hours of SLEEP do you get per night on average?
(Required)
On a scale of 1 (low) -10 (high), how would you rate your SLEEP quality?
(Required)
On a scale of 1 (low) -10 (high), what is your average ENERGY level like?
(Required)
On a scale of 1 (low) -10 (high), how do you feel about your weekly schedule, use of time and free time? Please explain.
(Required)
On a scale of 1 (low) -10 (high), what is your STRESS like?
(Required)
How do you cope with/alleviate stress? What are your top 5 things? What are your top 3 things that bring you joy/happiness/stress relief?
(Required)
Have you made changes to your health, fitness, nutrition or habits in the past 12 months? Please describe.
(Required)
What are you prepared to do to hit your goals?
(Required)
What goals do you want to achieve from this program over the next 12 weeks (Health, Fitness, Nutrition, Body Image and Stress Reduction.
(Required)
Of the above, what are the most important 3 in order?
(Required)
Please share anything else that may be helpful for us to know as we get started on crafting your program.
(Required)
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One-Time Custom Macro Count quantity
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One-time Fee
Description
Description
Macros Built for Ypour Body, Goals & Lifestyle
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