Nutrition Application

Personal Information

First Name

Last Name

Postal Address

Email Address

Contact Number

Date of Birth

Health History

What is your current weight (kg)?

What is your height (cm)?

Do you have any of the following medical conditions:
Please check if any conditions that might apply to you. If your condition is not listed then please check "other".

DiabetesDigestive problemsIrritable Bowel Syndrome (IBS)Polycystic Ovary Syndrome (PCOS)High Blood PressureOther (please specify)

Please specify

Do you have any injuries?
YesNo

Please specify

Do you have any food allergies?
YesNo

Please specify

Are you pregnant or have recently given birth?
YesNo

Do you smoke?
YesNo

Do you drink alcohol regularly?
YesNo

Nutrition History

What is your current calorie intake?
Please enter "unknown" if you don't know this information.

What is your current macronutrient intake (carbohydrates, fat and protein in grams)?
Please enter "unknown" if you don't know this information.

Have you tried dieting before?
YesNo

What diets have been successful for you and why?

What diets have NOT been successful for you and why?

Are you currently adhering to a specific diet?

Training History

How many days per week do you currently lift weights?

How many days per week do you currently do conditioning (cardio)?

Please choose one of the following boxes to indicate the amount of physical activity (and perceived intensity) you perform on a daily basis:
Very LowLowModerateActiveVery Active

Which types of training have you had previous experience with?
Cardiovascular trainingEndurance trainingStrength trainingHypertrophy trainingFlexibility trainingOther (please specify)

Goal Setting Information

How do you perceive your current level of fitness?
LowAverageGoodHigh

On a scale of 1 to 10, how happy are you with your current body composition?
Please enter a value between 1 and 10.

What are your health and fitness goals?

What are your body composition goals?

How many days per week can you dedicate to training and conditioning?
Please enter a value between 1 and 7.

Are you prepared track, weigh and measure food to get optimal results?
YesNo

Would you prefer your Nutrition Consultation In-Person or Online?
In-PersonOnline

Terms and Conditions

I confirm that by selecting this box I accept the Terms and Conditions laid out by Rachael Fisher trading as Strength Nutrition (ABN 77 845 396 118).

To read the terms and conditions please click here.