Let’s work together! Tell me more about you… Name * First Name Last Name Email * Phone * Country (###) ### #### Age Gender Current Weight * Goal Weight (if applicable) Height * Do you have any medical conditions or health concerns? * Yes No If yes, please explain: Are you currently taking any medications or supplements? * Yes No If yes, please list: Do you have any dietary restrictions, allergies, or intolerances? * Yes No If yes, please specify: Have you followed any specific diets in the past? * Keto Carnivore Paleo Vegan/Vegetarian Low Carb Other If yes, please specify: What have been your biggest challenges with past diets? * Cravings Consistency Energy Levels Lack of Results Emotional Eating Other If yes, please specify: Do you struggle with any of the following? * Food Addiction Emotional Eating Cravings Low Energy Other If other, please explain: Are you familiar with the carnivore or keto diet? * Yes No If yes, how comfortable are you with these eating styles? * Do you exercise regularly? * Yes No What type of exercise do you do? * Strength Training Cardio (Running, Cycling, etc) HIIT Yoga/Pilates Other If other, please specify: What are your fitness goals? * Build Muscle Lose Fat Improve Endurance Improve Overall Health Other If other, please explain: What are your top 3 goals? * What do you feel you need the most help with? * Meal Planning Accountability Motivation Overcoming Cravings Strength Training Plan Other If other, please specify: What’s the biggest obstacle holding you back from reaching your goals? * On a scale of 1-10, how committed are you to achieving your fitness/nutrition goals? * 1 = Not committed, 10 = Extremely committed 1 2 3 4 5 6 7 8 9 10 Is there anything else you would like me to know about your goals, lifestyle, or health? Which of my coaching options are you most interested in? Basic Nutrition Premium Nutrition One-Time Consultation Combined Strength + Nutrition Group Coaching I'm Not Sure Yet Thank you for sharing your goals with me! Schedule your 15 minute discovery call now to chat with Jess about next steps!
