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[Insert Gym Name]30-Day Nutrition Challenge Intake ConsultationName: ______________________________ Date: ________________InBody scan and review/measurementsBefore picturesGoal planning/questionsMeasurements: [if you are not using an InBody or other machine, use this section to log any measurements you take. If you use a machine, we recommend you photograph the printout.]Goal planning:What motivated you to sign up for our nutrition challenge?What nutritional guidance have you had in the past? Did you get results?What are you hoping to accomplish in this challenge?Rate your goals on a scale of 1-10.(10 = most important, 1 = least important)GOALRATING (1-10)GOALRATING (1-10)Lose weightBuild lifelong healthy habitsAdd muscleEat well more consistentlyFeel betterIncrease confidenceGain energy/vitalityImprove sports performanceTake control of eatingLearn more about nutritionClient Lifestyle/History 1. What do you eat and drink on a typical day? Do any foods not agree with you?Food/DrinkNotesBreakfastSnackLunchSnackDinnerSnack2. Do you get at least seven hours of sleep per night?3. Have you ever logged your food?4. What is your biggest nutritional challenge?5. Do you have medical history/medications/injuries I need to be aware of? 6. May we use your before/after pictures and results to celebrate your success on social media and our website?What questions do you have for us? ................
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