Quarterly Challenge Intake Form | Warrior Fitness

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Please fill this form out with as much detail as possible. This information will be used to create your plan and to best coach you, so you get results and achieve your goals.

You will be added to the Warrior Fitness app a few days prior to the start of the challenge!

First Name

Last Name

Email

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

IG handle

Please make sure we are Facebook friends - Stephanie Pond Lawler) and make sure you are in my private Team Warrior Fitness FB Group

Birthdate

Age

Height (inches)

Weight (pounds)

What is your GOAL weight:

Do you have a basic understanding of macros and how to track them? *

Yes

No

Occupation and how active you are at your job:

Current daily level in your daily life. Do not consider workouts in how you answer. (IE - most of us are sedentary)

1 (completely sedentary)

2

3

4

5 (Moving Non-Stop)

Current type of exercise and frequency (home or gym?)

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:

02:30 PM

What time do you workout:

02:30 PM

What time do you go to bed:

02:30 PM

How many calories do you consume in a day on average based on tracking in My Fitness Pal? If you don't know, what is your estimate:

Do you want custom macros or a general portion control plan *

Custom Macros

General Portion Control Plan (this will be palm/fist/fist plan with no numbers or meal plan)

If you chose macros above, how do you want to track your food? *

Track within the Warrior Fitness app (this choice allows you access to the recipe bank/library)- this is preferred

Track using My Fitness Pal (it syncs with the WF app)

Prescription medications taken (list name, dosage, and what for)

Health issues, physical restrictions, recent surgeries, allergies:

Do you smoke? *

Yes

No

Do you drink? *

Yes

No

If you smoke and/or drink, how much:

What is your goal for this group challenge? *

Fat/Weight loss

Muscle Gain

Maintenance / healthy lifestyle at current weight

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 are your fears? Who is your support system?

What is your "why" in doing this? Why do you want to better yourself or your health (a deeper reason that your goal). Why is this important to you right now?

What is your goal for this group challenge? *

1 (Not Committed)

2

3

4

5

6

7

8

9

10 ( I will die trying!)

How accountable do you want me to keep you? *

1 (None)

2

3

4

5

6

7

8

9

10 ( Hold my feet to the fire)

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.

Do you tend to prefer/eat more carbs (breads, pasta, potatoes, rice, grains, cereal, oats, etc) or more fats (cheese, nuts, nut butters, oils, dairy, etc) *

Carbs

Fats

I like both evenly

What foods/drinks MUST you keep in your daily intake?

Is there anyone you would like to be an accountability partners with? How did you find this group?

Do you understand that to be part of this group, you are expected to log/track your daily intake in app, use the Warrior app daily and for all communication with Stephanie, do the assigned workouts or your own, attend weekly Zoom calls with the team, submit your weekly check-in, be a good accountability partner, and be coachable? These are the requirements for this group and are NON-NEGOTIABLE. *

Yes

No

Ladies Tank Size *

Small

Medium

Large

XL

2XL

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.

I acknowledge the above paragraph. *

Yes

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!

Stephanie Lawler

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