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👤 CLIENT INFO


*if at any point something does not apply to you, just put down N/A.

🎂 Age

📏 Height (in feet + inches)
(Example: 5’7”)

⚖️ Current Weight (lbs)

🎯 Goal Weight (lbs)


👟 Movement & Training

I don’t care how fit you are right now — I care how hard you’re willing to work. This section helps me match your plan to your mindset and lifestyle.

 🚻 What’s your biological sex?

(Required — used to build the correct training, nutrition, and hormone-supportive protocol for your body.)

 🚻 What’s your biological sex?(Required — used to build the correct training, nutrition, and hormone-supportive protocol for your body.)
A
B

👣 How many steps do you average daily?
(Estimate is fine — check your phones health app, or watch if unsure.)

🏋️‍♀️ Current Workout Routine. How many times per week do you work out?
(Include lifting, cardio, active sports, or job related activity like heavy construction, etc.)

⏰What time of day do you prefer to work out?

(Only your pre/post workout meals will be structured — the rest are flexible. These are called Anytime meals.)

🗓️How many days per week do you want to work out? Pick an exact number 1-6 (you need minimum 1 rest day. Normally the 7th day.)

📸 If you work out at home, upload clear photos of ALL your home equipment — dumbbells, bench, TRX, bands, foam rollers, anything you use. (Multiple images allowed — just snap and drop!)

♀ Female-Specific Cycle Tracking

(We use this to adjust workouts and nutrition based on your hormone phase — especially during your period when cortisol sensitivity is highest.

🩸Are you currently cycling?

Other

🔹 Conditional Question: Pregnancy/Postpartum Details

I’ll be adjusting your plan to support recovery, milk supply, and hormone health.

⭕️ Do you know the first day of your last period?(Approximate is fine)

📅 If pregnant, how far along are you 🚼

🍼Are you nursing, planning to nurse, or I don't know yet

🥵Are you experiencing menopause or early-onset menopause? (Yes/No/I don't know/Maybe)

💊Are you taking any medication or supplements for it?

(Examples: estrogen patch, progesterone cream, DIM, maca root, ashwagandha, DHEA, testosterone cream, black cohosh, or HRT blends

🧠💥Any recent changes in sex drive, mood, or muscle recovery?

♂ Male specific. 


Testosterone-Supportive Strategy

(Used to align meal plans, supplements, and recovery to support testosterone, energy, libido, and muscle-building.)

🧪Have you ever been diagnosed with low testosterone? (Yes/No. do you know what your current testosterone level is, or what it was when you last had it checked, and when was that?)

💊Are you currently taking any testosterone support (TRT, Clomid, supplements)?

🧠💥Any recent changes in sex drive, mood, or muscle recovery?

🩺 Health Conditions & Medications. (If you’re taking meds, supplements, or feeling bloated and backed up like a 2005 septic tank, I need to know — because timing and absorption matter.)

📝 List all current or past diagnosed medical conditions, with timeline.

🧠 Any mental or emotional health conditions?

💉 Are you on hormone replacement therapy (HRT)? (In case you missed this one higher above? Yes / No / I think I probably should. If so, tell me why.

⏰ Current medications & timing (include food interactions):Some meds require or restrict certain foods to work properly. (e.g., I take Synthroid at 6 AM on an empty stomach. Can’t eat for 30 mins. No calcium or magnesium for 4 hours. I take Zoloft at night with food.)

⚠️ Upload clear, readable photos of all medication and supplement labels — front and back

🔥 Why Timing + Food Matters with Medications

Some medications block or reduce nutrient absorption. For example:• Antibiotics wipe gut flora → lowers B vitamin & K2 synthesis• Omeprazole (PPIs) reduces magnesium & B12• Metformin depletes B12 and folate• Thyroid meds are blocked by calcium, iron, or fiber• Statins lower CoQ10 → impacts energy production

🧪 Lab Work & Testing

 • Upload any labs from the past year. (PDF or clear photo)• Omega-6:3 Ratio & Inflammation Test• Cellular Nutrient Absorption Test• Hormone Panel (thyroid, insulin, etc.)• Standard Bloodwork (vitamin D, B12, iron, etc.)

🧠 Gut, Sleep, and Energy

💩How many times per day do you poop?(Include consistency: soft, hard, urgent, incomplete, etc.)

🪱 When last did you detox, or take appropriate lab work for it? (Heavy metals, parasites, toxic chemical buildup, etc.? 🖐️THIS IS NORMALLY DONE THROUGH AN ALTERNATIVE MEDICINE DR OR PRACTITIONER. NOT YOUR NORMAL WESTERN MEDICINE HEALTH PROVIDER(S).

📊 Describe your energy levels (morning, midday, evening, crashes?)

💤 Describe your sleep quality and average hours of sleep

🧃 Pantry, Food & Supplement Uploads.

⚠️ Photos must be clear. Unreadable = re-upload.

🧠 Why We Need Clear Photos of Your Food, Spices & Supplements

I’m not just scanning for calories or macros. I’m scanning for ingredients that quietly sabotage your metabolism, gut health, and hormones — even in foods labeled “healthy.”

⚠️ Here’s what I’m looking for:

• Artificial additives and preservatives

• Inflammatory seed oils (canola, soybean, safflower, etc.)

• Synthetic sweeteners (sucralose, aspartame, acesulfame potassium)

• Anti-digestive compounds (like gums, thickeners, emulsifiers, and phytic acid)

• Hidden gluten derivatives

• Pesticide exposure — especially glyphosate (a hormone-disrupting chemical sprayed on wheat, corn, soy, oats, etc.)

• Chemical ingredients that inflame your gut lining, slow nutrient absorption, spike blood sugar, and disrupt neurotransmitters


🌾 And About Gluten…

Most people aren’t truly allergic to gluten — they’re reacting to hybridized, glyphosate-sprayed wheat stripped of its natural structure.


✅ Better grain options:

• Organic Einkorn wheat

• Spelt or Kamut

• Sprouted grains

• Traditional fermented sourdough


🔥 If your food isn’t helping your digestion, energy, skin, libido, sleep, and mental clarity… it’s working against you.

📸All food in pantry, fridge, and freezer (front & back labels)

📸All condiments (front & back labels)

📸 All spices (front & back labels)

📸 All supplements (front, back, and nutrition label)

🍴 Food Preferences & Restrictions

🥴Any food allergies or intolerances

🤢 Foods you dislike or won’t eat

🥩🥬🍚🧈 List your favorite proteins, carbs, veggies, and fats

⏲️ Dietary preferences (snacks vs. meals, fast-prep needs, etc.)

🙏🏻 Religious or cultural dietary needs (halal, kosher, etc.)

🤓 Lifestyle Preferences

⏰ Wake-up time and bedtime

🥄 Typical eating schedule (meal count, timing, snacking?)

🍽️ Preferred number of meals per day (e.g. 3 meals, 4 meals, 2 meals + snacks, etc.)

👩‍🍳 Cooking ability:

👩‍🍳 Cooking ability:

🛒 How often do you see yourself grocery shopping? How many times per week?

💵 What is your weekly food budget?

🎯 What are your transformation goals?

(Fat loss, maintenance-toning, muscle gain, etc.)
Do not say weight loss. Weight loss is the incorrect term for fat loss. Just the same as weight gain means muscle gain. It does not.
⚠️ Real talk: You can’t do it all at once.
Fat loss, muscle gain, and “toning” are each done in separate phases — and each one has a specific strategy: • Fat loss = 🔥 Caloric deficit • Muscle gain = 🍽️ Caloric surplus • Toning = ⚖️ Maintenance — slow body recomposition while keeping weight steady (give or take 5 lbs)
🧨 And no — you cannot build muscle and burn fat at the same time unless you’re a beginner or using performance enhancers. Period.
✅ You’ll choose one goal to focus on right now. The others come later — in the right order.
💬 That said — no matter what phase you think you’re ready for, I’ll likely start you in a maintenance phase (for 2–4 weeks) to stabilize your body first. ⚠️ Why? If you’ve been chronically dieting or skipping meals, your metabolism is likely tanked. We’re not diving into a fat loss cut with a broken foundation. We’re also not pushing you into a muscle gain phase when your digestion can’t handle more food — that’ll backfire fast. 🛠️ We’ll build the phase your body’s actually ready for — based on your internal status, not just your preference.

🐦‍🔥Enter your transformation goals👇

🔥 Fat Loss  / ⚖️ Maintenance-Toning  / 💪 Muscle Gain  / 🏃‍♀️ Endurance. /🤔Other (explain) ~>medical conditions or performance-specific goals (e.g. Spartan Race prep, post-op recovery, etc.).

⁉️Other

🧪💊 Willingness to Use Recommended Products

🔍 I only recommend products I’ve personally researched, used, or fully trust. ✅ After reviewing what you’re currently taking, I’ll either keep what works — or swap out what doesn’t. 🗑️ If something needs to be tossed or replaced, I’ll explain exactly why. 🚫 No fluff. No BS. Just what actually moves the needle, so you know where your money is better spent.
📝Yes/No/ Other(Explain). If they are Dr recommended, what is Dr Email so we can work together.

🌿 Open to anti-inflammatory food rotation or detox protocols?Have you already started one or looked into something you’d like me to review or tweak?

🎯 Any additional goals? (Libido, skin, fertility, mental clarity, strength, etc.)

📣What to Expect once you start.

• You’ll hear from me 1–2x per week. I don’t give up on you — and I expect the same. Communicate. No ghosting.

• I’ll reach out via text (US only) or your preferred messenger app (international).

• If something’s off — we troubleshoot and adapt. Coachability = progress.

• Pausing isn’t an option. If you fall off — don’t panic. Shake it off and get back on. We keep collecting data.

• Life will happen — expect:

  🍕 Pizza night

  ✈️ Last-minute travel

  🍭 Funnel cake at the fair

  ⏰ Running late or eating on the go

This isn’t a rigid diet — it’s a system that teaches you how to thrive in chaos.

We adjust real life into your plan — not the other way around.

🚫 No more Copout excuses.

🔥 Time to be that confident sexy beast that gets sh!t done.


📸 💥Progress Photos & Transformation Goals

📸 Permission to Share Results

🛡️ Consent & Media Release

Please review and select one option:


Do (or how do) you give permission to share any part of your transformation?

📸 Permission to Share Results🛡️ Consent & Media ReleasePlease review and select one option:Do (or how do) you give permission to share any part of your transformation?
A
B
C
D
E

📸 Upload your front, side, and back photos in swimwear or tight-fitting clothing. These are required for me to build your plan. No filters. No baggy clothing. You will be asked to redo them if not followed the directions.

🚦 Did you upload all required progress photos (front, side, back in Swim attire, or tight fitting clothes)?

🚦 Did you upload all required progress photos (front, side, back in Swim attire, or tight fitting clothes)?
A
B

⚠️ You can't skip this part. Your plan won't be reviewed until all progress photos are uploaded. Come back when you're ready to show me what were working with.

🛠️ Expectation vs Reality, and Commitment Level

🔧 What This Commitment Actually Means: This isn’t a quick-fix program. If you’ve been chronically dieting or dealing with hormone, digestion, or inflammation issues — we’ll need to repair your internal system before any real physical change sticks.Also — if you don’t have recent blood work, just know: Real transformation starts on the inside. The more internal data we have, the more customized — and life-changing — your plan will be. We can help you: Here’s the timeline based on your consistency and starting point:

📅 When do you want to start? Pick the exact date you're ready to Get Your Sh*t Together. -This helps me map your plan out right

✍️ Signature (Required to continue) Please sign below to confirm you’ve read and agree to the expectations above.

Signature

📄 By submitting this form, you agree to our Privacy Policy and Terms of Service.

🎉 Thank You for being so thorough.
🎯 Done! Once you submit your info we’ll review everything and start building your transformation plan. If we need anything else, we’ll text you directly.
You’re officially closer to feeling amazing.