Personal Training – Nutrition Program

Nutrition Program Intake

Please complete this form so your coach can design a personalized nutrition program aligned with your goals and lifestyle. This is not medical nutrition therapy.

Full Name(Required)

Preferred Name(Required)

Email(Required)

Phone(Required)

Age(Required)

Height(Required)

Weight (optional)

Emergency Contact & Phone:(Required)

Nutrition Goals

Primary goal (fat loss, muscle gain, energy, performance, habits, etc.)(Required)

Secondary goals:(Required)

Dietary Preferences & Restrictions

Dietary style (omnivore, vegetarian, vegan, keto, paleo, etc.)(Required)

Food allergies or intolerances(Required)

Foods you dislike or avoid(Required)

Foods you enjoy(Required)

Current Eating Habits

Meals per day(Required)

Typical snacks(Required)

Typical beverages (water, coffee, soda, alcohol)(Required)

Meals eaten out per week(Required)

Nutrition Experience

Have you followed a nutrition plan before?(Required)

Yes

What worked well(Required)

What did not work(Required)

Health & Lifestyle Considerations

Medical conditions trainer should be aware of(Required)

Medications or supplements (optional)

Average sleep per night(Required)

Stress level (low / moderate / high)(Required)

Program Preferences

Preferred approach (meal plan, macros, habits, flexible)(Required)

Cooking skill level (beginner / intermediate / advanced)(Required)

Budget considerations for groceries(Required)

Additional Notes: Anything else your coach should know

Acknowledgment(Required)

I understand this nutrition program is for general health and fitness purposes only and does not replace medical advice. I confirm the information provided is accurate and agree to communicate any changes in health status.

Client Signature(Required)

Date(Required)

Coach Signature(Required)

Date(Required)