Built By Plants Coaching

Your Name: *

Your Email Address *

Cell Phone Number *

City (Important to know local grocery stores)

State

I am a

Male

Female

Instagram name (just in case I can't reach you via email)

WHAT ARE YOUR GOALS?

Everyone has their own reasons for working on improving their health and fitness. Tell me what results you're after.

Please rate your readiness for change. (On a scale of 1-10)
Losing Weight
Building Muscle
Looking and feeling better?
Learn how to stay consistent?
Gain more energy?
Get off medications?
Get stronger?

I want to:

Mostly want to lose fat

Move better, lose some fat, and gain some strength.

Put on some size

Mostly want to build muscle; I’m not concerned with fat loss.

What's been your biggest struggle with reaching your goal? *

TRACKING YOUR PROGRESS

To help you track your progress over the year, I'll ask you to share some progress photos and record certain measurements.

Height:

Age:

What's your Birthday?

Current Weight:

Goal Weight:

Your Before Pics (Current) Front, Back & Side

How would you describe your normal daily activities?

Sedentary: Spend most of the day sitting (e.g. bank taller, desk job)

Lightly Activity: Spend a good part of the day on your feet (e.g. teacher, salesman)

Active: Spend a good part of the day doing some physical activity (e.g. waitress, mailman)

Very Active: Spend most of the day doing heavy physical activity (e.g. bike messanger, carpenter)

How many days per week are you available to workout?

How many minutes per day do you exercise (cardio & weight lifting combined)?

LET'S TALK ABOUT NUTRITION

What is your biggest nutritional challenge?

If you had to pick just one nutritional struggle from the list above, which challenge would you consider to be your most difficult to overcome and why?

On an average day, how many glasses of water do you drink?

0-2

3-5

6-8

On a scale of 1-10, how knowledgeable are you about making smart food choices?

Dietary Preferences

Which best describes you?

I want basic, inexpensive, routine meals to make to reach my goals (Most affordable due to a simple grocery list)

I need a wide variety of weekly meals to stick to my meal plan. (More costly due to a larger grocery list.)

I'm not picky, I want the best meal plan that'll help me accomplish my body goals.

ARE THERE ANY (VEGAN) FOODS THAT YOU REFUSE TO EAT?

What Kind of Breakfast would you like?

Fluffy Vegan Pancakes

Strawberry Banana Proats

Vanilla & Chocolate Protein Pancakes

ARE THERE ANY VEGAN FOODS THAT YOU REALLY WANT TO EAT?

What's your Work Schedule?

Number of Meals Per Day:

Number of Snacks Per Day:

How Many Different Lunches do you want Mon-Sun?

How many different Dinner meals do you want Mon-Sun ?

LET'S TALK ABOUT TRAINING

How would you describe your exercise level?

Level 1: I've never really exercised before

Level 2: I have some experience but it's limited

Level 3: I feel comfortable with many different exercises

Level 4: I'm very experienced with many different exercises

Level 5: I'm advanced and have had high-level exercise and movement coaching

How many days per week can you commit to working out?

What is your goal with your training and Why?

What’s your biggest exercise challenge? The thing that makes it difficult for you to stay consistent or make progress with exercise?

What days of the week would you like to do your workouts? (Check All that apply)

If you have any diagnosed health problems list the condition(s).

If you are taking any prescription medications, please list them.

If you have any injuries, please list them.

How would you currently describe your sleep habits?

Are you experiencing any stresses or motivational problems?

Please list the physical activities that you participate in outside of the gym and outside of work:

Which would you like to start off with?

Gym Workouts

At-Home Workouts

What's your work and family life like?

What do you do for a living?

Do you work days, afternoon or nights?

Days (ex. 9am-5pm, etc.)

Afternoons (12pm-9pm, etc.)

Nights (11pm-7am, etc.)

I have a rotating schedule and do shift work

What's your activity level at work?

Inactive; I'm mostly sitting

Moderate; I'm on my feet for a part of every day

Active; I'm moving all day

Very active; I do physical labor

What is your typical stress level at work?

Low stress; my work is pretty relaxed

Moderate stress; it's sometimes relaxed and sometimes crazy

High stress; I'm always under pressure

Is there anything else we should know that would be useful for tailoring your plan?

ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY, AND INDEMNITY AGREEMENT DECLARATIONS: * * At Built By Plants, we're dedicated to finding and using the best possible evidence- and research-based nutrition practices. Because of that mission, this program will help you get into the best shape of your life. It'll also help me create more and better evidence and research... so others can eventually benefit from our experience and knowledge. I often use data from our clients as testimonials, but only after successful transformations. Before doing so, I like to get your consent to include your data in current and future publications. Therefore... "I agree to let Built By Plants use the information they collect in this program in current and future case studies." I understand that there are no risks associated with saying yes, and by allowing my information to be used in this way, I'll be helping further the field of exercise and nutrition science. Medical release Every individual who has regularly attended and completed our coaching programs has gotten healthier and fitter. But we still need to be sure that you take full responsibility for your health and the monitoring of it. It's important that you understand: Our advice cannot — especially with distance-based coaching — replace the advice of a trained medical doctor. It is your responsibility to work directly with your physician before, during, and after seeking group coaching with Built By Plants or any other specialized consulting group. If you choose to be coached by us without the prior consent of your physician, you agree to accept full responsibility for your decisions and to hold harmless Built By Plants, its agents, officers, and employers and any affiliated companies from any liability with respect to injury to you or your property arising out of or connected with your use of the information discussed. Yes, I agree with terms and conditions above.

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