Are you a current 1stPhorm customer (either through ordering supplements or are in the 1stPhorm app)? If so, what name and email do you use for ordering?
Supplements used and brand (if any) including vitamins, minerals, protein, preworkouts, etc.:
What time do you wake: 12:00 AM 12:15 AM 12:30 AM 12:45 AM 01:00 AM 01:15 AM 01:30 AM 01:45 AM 02:00 AM 02:15 AM 02:30 AM 02:45 AM 03:00 AM 03:15 AM 03:30 AM 03:45 AM 04:00 AM 04:15 AM 04:30 AM 04:45 AM 05:00 AM 05:15 AM 05:30 AM 05:45 AM 06:00 AM 06:15 AM 06:30 AM 06:45 AM 07:00 AM 07:15 AM 07:30 AM 07:45 AM 08:00 AM 08:15 AM 08:30 AM 08:45 AM 09:00 AM 09:15 AM 09:30 AM 09:45 AM 10:00 AM 10:15 AM 10:30 AM 10:45 AM 11:00 AM 11:15 AM 11:30 AM 11:45 AM 12:00 PM 12:15 PM 12:30 PM 12:45 PM 01:00 PM 01:15 PM 01:30 PM 01:45 PM 02:00 PM 02:15 PM 02:30 PM 02:45 PM 03:00 PM 03:15 PM 03:30 PM 03:45 PM 04:00 PM 04:15 PM 04:30 PM 04:45 PM 05:00 PM 05:15 PM 05:30 PM 05:45 PM 06:00 PM 06:15 PM 06:30 PM 06:45 PM 07:00 PM 07:15 PM 07:30 PM 07:45 PM 08:00 PM 08:15 PM 08:30 PM 08:45 PM 09:00 PM 09:15 PM 09:30 PM 09:45 PM 10:00 PM 10:15 PM 10:30 PM 10:45 PM 11:00 PM 11:15 PM 11:30 PM 11:45 PM 02:30 PM What time do you workout: 12:00 AM 12:15 AM 12:30 AM 12:45 AM 01:00 AM 01:15 AM 01:30 AM 01:45 AM 02:00 AM 02:15 AM 02:30 AM 02:45 AM 03:00 AM 03:15 AM 03:30 AM 03:45 AM 04:00 AM 04:15 AM 04:30 AM 04:45 AM 05:00 AM 05:15 AM 05:30 AM 05:45 AM 06:00 AM 06:15 AM 06:30 AM 06:45 AM 07:00 AM 07:15 AM 07:30 AM 07:45 AM 08:00 AM 08:15 AM 08:30 AM 08:45 AM 09:00 AM 09:15 AM 09:30 AM 09:45 AM 10:00 AM 10:15 AM 10:30 AM 10:45 AM 11:00 AM 11:15 AM 11:30 AM 11:45 AM 12:00 PM 12:15 PM 12:30 PM 12:45 PM 01:00 PM 01:15 PM 01:30 PM 01:45 PM 02:00 PM 02:15 PM 02:30 PM 02:45 PM 03:00 PM 03:15 PM 03:30 PM 03:45 PM 04:00 PM 04:15 PM 04:30 PM 04:45 PM 05:00 PM 05:15 PM 05:30 PM 05:45 PM 06:00 PM 06:15 PM 06:30 PM 06:45 PM 07:00 PM 07:15 PM 07:30 PM 07:45 PM 08:00 PM 08:15 PM 08:30 PM 08:45 PM 09:00 PM 09:15 PM 09:30 PM 09:45 PM 10:00 PM 10:15 PM 10:30 PM 10:45 PM 11:00 PM 11:15 PM 11:30 PM 11:45 PM 02:30 PM What time do you go to bed: 12:00 AM 12:15 AM 12:30 AM 12:45 AM 01:00 AM 01:15 AM 01:30 AM 01:45 AM 02:00 AM 02:15 AM 02:30 AM 02:45 AM 03:00 AM 03:15 AM 03:30 AM 03:45 AM 04:00 AM 04:15 AM 04:30 AM 04:45 AM 05:00 AM 05:15 AM 05:30 AM 05:45 AM 06:00 AM 06:15 AM 06:30 AM 06:45 AM 07:00 AM 07:15 AM 07:30 AM 07:45 AM 08:00 AM 08:15 AM 08:30 AM 08:45 AM 09:00 AM 09:15 AM 09:30 AM 09:45 AM 10:00 AM 10:15 AM 10:30 AM 10:45 AM 11:00 AM 11:15 AM 11:30 AM 11:45 AM 12:00 PM 12:15 PM 12:30 PM 12:45 PM 01:00 PM 01:15 PM 01:30 PM 01:45 PM 02:00 PM 02:15 PM 02:30 PM 02:45 PM 03:00 PM 03:15 PM 03:30 PM 03:45 PM 04:00 PM 04:15 PM 04:30 PM 04:45 PM 05:00 PM 05:15 PM 05:30 PM 05:45 PM 06:00 PM 06:15 PM 06:30 PM 06:45 PM 07:00 PM 07:15 PM 07:30 PM 07:45 PM 08:00 PM 08:15 PM 08:30 PM 08:45 PM 09:00 PM 09:15 PM 09:30 PM 09:45 PM 10:00 PM 10:15 PM 10:30 PM 10:45 PM 11:00 PM 11:15 PM 11:30 PM 11:45 PM 02:30 PM Prescription medications taken (list name, dosage, and what for)
Health issues, physical restrictions, recent surgeries, allergies:
If you smoke and/or drink, how much:
Please tell me your goal/committment in these areas: 1. weight and/or inches lost, 2. physical health improvement, 3. mental health improvement, 4. lifestyle improvement, 5. what doyou want t learn?
What information about you would be helpful for me as your coach and friend? Notes, extra information, etc. :
Are there any previous injuries, surgeries, or limitations that I need to be aware of?
Please complete the following section to help me design your custom macro plan.
What previous diets have you followed? Which did you find successful? Which were unsuccessful?
Log what a typical day of eating (including all liquids) looks like for you including times and approximate amounts.
Thank you for choosing Warrior Fitness for your health and wellness needs. Please note that I am not a licensed nutritionist, dietician, or mental health professional. By clicking the button below, you hold me harmless from any liability, illness, injury, or death that may occur during our contracted time or thereafter. Please consult with your physician before starting any weight loss, health, or exercise plan.
Thanks for submitting! You will be added to the Warrior Fitness app a few days prior to the start of the challenge. Your macros, goals, and habits will be in the app for you at that time!
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