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Resist – Persist – Overcome
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Xtreme Fat Loss Programme
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About
The Resilience Coaching Principles
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Home
Blog
Services
Xtreme Fat Loss Programme
About
The Resilience Coaching Principles
Contact Me
Initial Nutrition Assessment
Name
*
First
Last
Email
*
What is your main goal?
*
Fat Loss
Muscle Gain
Improved health
What approaches have you tried so far?
*
Which have been the most effective?
*
How did you determine their effectiveness?
*
How many meals a day do you normally eat?
*
Less than 3 a day
Between 3-5 a day
More than 5 a day
Do you normally have breakfast?
*
Yes
No
Do you know on average how many calories you consume on a daily basis?
*
Yes
No
How much plain/pure water do you consume on a daily basis?
*
Less than 1.5l a day
Between 1.5-2.5l a day
More than 2.5l a day
How many servings of vegetables do you consume a day?
*
Less than 4 a day
Between 4-6 a day
More than 6 a day
How active are you on a daily basis?
*
Very active
Quite active
Not very active
Mostly sedentary
What time do you go to sleep each night?
*
What time do you wake up each morning?
*
Do you have any food allergies, intolerances or sensitivities?
*
Yes
No
Please provide details
*
Do you suffer from any dietary medical conditions (IBS, SIBO, Crohns, Coeliac, etc)?
*
Yes
No
Please provide details
*
Are you human? If so, please enter the details from the image below.
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