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Macro and Energy Calculations

Age

Current Weight

Goal Weight

Current Exercise Routine

Please provide as much detail as possible including length, exercise type and intensity

Current Health

Please list any pre existing health conditions:

Please list any food allergies:

Please list any food intolerances or other dietary issues:

Please list any known nutritional deficiency issues and any current treatment plans or medications:

Please list anything else that may affect your dietary intake:

Goal Setting

Please list your health and nutrition based goals:

Please list any issues you may have with reaching these goals:

What accountability do you have to reaching these goals:

Current Diet

With as much detail as possible, please give a description of a "normal" day of eating:

Please list any food/dietary preferences, regardless of reason:

BUILD IT PLANNING

Please list anything else you wish included:

Is there anything else you wish to add:

Are you ready to build it balanced?