Fit Forward Mom

First name*

Last name*

Email*

Confirm email*

Which program are you interested in investing in?*

City, State (or country if outside of the States)*

Birthday/Age*

Height*

in feet & inches

Current Weight*

in pounds

Are you currently pregnant or trying to conceive?*

If you are currently 3 years postpartum or less, how old is your baby(ies)?*

If less than 4 months old, please state in weeks

If fewer than 12 weeks postpartum, do you understand that calories cannot be factored for a deficit and that rapid weight loss will not be emphasized in this period?*

If between 12-26 weeks postpartum, do you understand that while in the midst of a major hormonal shift progress may not be best represented by the scale alone?*

At how many weeks gestation was baby(ies) born?*

Baby's Date of Birth*

Are you currently breastfeeding?*

Please tell me your pre-pregnancy weight for this most recent pregnancy*

in pounds

Goal Weight*

in pounds

Please tell me a little bit about yourself and your family*

Have you ever worked with a nutrition/macros coach before? If yes, who?*

How would you rate your average activity level?*

Please describe your activity/workouts. If you anticipate your activity level changing, please describe your planned changes and anticipated timeline of implementation.*

What goal(s) would you like to achieve over the next 3 months?*

What goal(s) would you like to achieve over the next year?*

How experienced are you with tracking macros?*

On a scale of 1 – 10, how dedicated are you to reaching your goal(s)?*

1- My health and fitness isn't a top priority right now, so I'm hoping to achieve my goals with the minimum amount of changes/effort. 10- My health and fitness is a top priority and I plan to invest time and energy daily towards my goals

What do you consider to be your major obstacles in reaching your goal(s)?*

How long do you think is a reasonable amount of time to reach your goal(s)?*

Are you currently tracking your food intake? If so, please include your current targets, macro splits (if you know them), and compliance level.*

How do you feel on and with your current nutritional intake?*

What weight loss strategies have you tried in the past?*

Tracking calories/macros, Keto/Low Carb, Paleo/Clean Eating, Branded Weight Loss Programs (Whole30, Weight Watchers, Nutrisystem, Shakeology, Jenny Craig, etc.)

Which tracking app do you prefer to use for recording meals and macros?*

Are you interested/able to invest in specific food items or additional supplements?*

e.g. lean meats and fresh produce, protein bars or powders, etc

Are you willing to buy in bulk and spend a couple of hours per week pre-making some meals?*

Are you okay with eating the same foods over and over for most of your meals, or do you require variety?*

Do you have any food restrictions and/or allergies?*

Would you like to drink alcohol as part of the plan?*

What is a guilty pleasure(s) that you would like to include as part of your day-to-day*

(e.g. candy bar, pop tarts, ice cream, bagel, glass of wine, etc.)

Do you have any medical conditions that we should be aware of?*

If yes, please describe in detail including any active treatment plan or restrictions from your medical provider*

Please list and describe any prescription and/or over-the-counter medications/vitamins/supplements you are currently taking.*

Do you suffer from constipation, IBS, or any other bowel issues?*

Describe any prior surgeries or injuries.*

Please describe your menstrual cycles.*

Describe your sleep habits*

e.g. what time you go to bed, how long it typically takes to call asleep, if/how often Baby wakes up, if you breastfeed/pump during the night, what time you wake up, how well rested you feel, etc.

Are you currently employed? If so, what do you do? Please describe you typical schedule including time(s) working from home/in office, commute time, flexibility.*

Is there any other information you'd like to share with me?*

How did you hear about us?*

If there was a specific person who mentioned us, please let me know so we can credit their account with referral points!

Do you have any questions for me at this time?*

Please email me at juliette@fitforwardmom.com if you have any difficulties submitting your application.