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Client Consultation Form

Food Diary

If you are interested in my services, please complete the following and send to me

Once I have had the opportunity to take a look at your profile, I will get in touch to discuss some options

appropriate to your goals and requirements

Client Consultation Form

Starting Picture
Do you want a meal plan, tailored macros so you can track yourself or are you more interested in mindful eating?
Are you pregnant (Please click)
How active are you in your daily life? 1 = very sedentary, eg desk job, no walking 5 = very active, eg labourer, on feet all day
Do you want a meal plan, tailored macros so you can track yourself or are you more interested in mindful eating?

Food Diary

Please try to fill this out as accurately as possible, please use 3 typical days as well. If you eat differently at the weekend please do an additional day or simply describe how you eat differently. Please also add in the notes, how many times you typically eat out in a week and anything else that is a part of your lifestyle that would be necessary for me to know (for example if you go out partying/drinking alcohol frequently or you have to wine and dine clients list in the notes).

I have answered all questions truthfully and to the best of my knowledge and I will inform the trainer of any change in my health. I hereby assume full responsibility for any and all injuries, losses and damages that I incur while attending, exercising or participating in any Nicole Danielle Fitness & Wellbeing training sessions or nutrition coaching.

Thank you for this information, I will be in touch shortly.

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