Nutrition Assessment

Fill out this form and coach Ted will assess your current nutrition and create a personal plan for you to improve things and start getting the results you want.

If you need ongoing weekly nutritional support, counseling, and accountability 1-on-1 Coaching would be a better fit.

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What are your fitness goals? *

• Fat loss
• Muscle gain
• Both
• Other*

* If other, list that goal here

Guaranteed Results!

If the nutrition plan doesn’t get you results, Coach Ted will adjust it for free until it does.

Age *

Must be at least 18 years old.

Biological Gender *

Height *

In inches or centimeters

Current Weight *

lbs or kg

How would you describe your overall food intake? *

• I tend to overeat
• I eat until I feel full
• I eat until I’m 80% full
• I’m always fearful of eating too much

Have you ever tried to track your daily calories and/or macros? *

• No
• Yes, calories only
• Yes, macros only
• Yes, calories and macros

🥦 How many servings of vegetables do you eat daily (on average)? *

• 1 or less
• 2-4
• 5+

🍑 How many servings of fresh fruit do you eat daily (on average)? *

• 1 or less
• 2-3
• 4+

🍗 What are your favorite protein sources? *

• Beef
• Poultry
• Fish/ seafood
• Pork
• Plant-based

🧁 How would you describe your sugar intake? *

• I crave it and need something sweet daily
• I have sweet treats occasionally
• I can live without it

How often do you eat out? *

• Daily
• On the weekend
• Once in a while
• I almost never eat out

What work do you do or what's your average non-exercise step count?

What's your current exercise schedule during a given week? *

💪 Example: Monday weight lifting 45 minutes (If you don’t exercise, you can state what you’d be open to doing.)

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

💊 Include any medications that could have metabolic side effects.

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

Name *

First

Last

Email *

I give Coach Ted permission to email me about my assessment and understand that this information doesn't constitute medical advice. *

• Yes

Get the results you're striving for. Coach Ted's expertise and experience will get you there. *

Price: $19.00

Preparing this for you takes 30 minutes of Coach Ted’s time.

⭐ Add our best selling nutrition program called The Macro Solution.

• Yes – $29.00

Includes step by step videos, a 138 page guide, meal plan, recipes, food lists, an eating out guide, and much more.

Your Total

$0.00

Credit/Debit Card *

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