Custom Nutrition Form

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What are your fitness goals?

Fat loss
Muscle gain
Both
Other*

* If other, list that goal here

Biological sex

Age

Height

In feet, inches, or centimeters

Weight

In pounds or kilograms

Do you know your body fat percentage?

(optional)

What do you do for work and how active is your job?

-or- how many steps do you get on average daily if you track those.

💪 Describe your weekly exercise including activities and duration.

➡️ Follow this format: Monday = Running 30 minutes; Tuesday = Lifting weights 45 minutes

Describe your eating style

Optional

List any other dietary restrictions or preferences you may have here.

This can help determine the best macro ratios for you.

Do you have any medical conditions that I should be aware of?

Also list any medications you currently take which could have have metabolic side effects.

Do you have any other lifestyle factors that should be considered?

Examples: Breastfeeding or pregnant, gastric surgery, work night shift, etc.

Is there anything else you would like Coach Ted's advice on to start?

I understand these calculations are not designed to treat medical conditions and I should consult your doctor before starting any new diet or fitness plan. All of your information is confidential.

Name

First

Last

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Custom Nutrition Form

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