Tell me more about yourself.

In this comprehensive client information sheet, I will ask you to provide relevant information about yourself. Your answers are essential to allow me to design an optimized individual program for you. Please answer all questions in the most accurate manner possible while being concise.

Disclaimer - Please recognize that it is your responsibility to work directly with your physician before, during and after seeking a fitness and nutritional consultation. As such, any information provided is not to be followed without prior approval of your physician. If you choose to use the information without prior consent, you are agreeing to accept full responsibility for your decision. 
Name *
Name
Goals
In the list below, please check which goal(s) are your primary focus.
Days per week
Intensity of Exercise *
On a scale of 1-10, rate the average level of intensity for your training.
Please list any diagnosed health condition(s).
Please list any medications, including pharmaceutical or nutracuetical interventions you currently take.
Please list any injuries and current treatments for those injuries.
Please list the typical level of activity associated with your work and/or day.
Does your job involve shift work?
Please provide a timetable of your most normal daily schedule listing the time you wake, work, have breaks, work out, and go to sleep.
How often do you travel
Please include lunch/dinner while at work. If you bring food from home, that is not considered dining out.
If there is any other information you think might be relevant to your program design, please share it with me. The more information you provide, the better I can develop a plan to help you reach your goals.
All the fun legal stuff
By checking this box, you acknowledge that you have read and understand the information provided by Lisa Desilet, MS in the Disclaimer of Liability (below). *
https://drive.google.com/open?id=0B78hCpImF0aOMnIyeGlIREVvRkk
Acknowledgement *
Acknowledgement
By signing below, you acknowledge that you understand that Lisa Desilet, MS is a health consultant and not a physician and that you should see a doctor if you think you have a medical condition. Lisa Desilet, MS will not be held liable for failure to diagnose or treat an illness, nor will she be liable for failure to prevent future illness. Additionally, you promise to give Lisa Desilet, MS a complete and accurate account of any medical conditions that you may have and any medications that you are taking.

The next step of the New Client Intake is to create a 5-day food log. MyFitnessPal is available online HERE. Once you set-up an online profile, download the app to your smartphone and begin logging!

In order to ensure accuracy of your customized nutrition plan, your food log needs to be as close to normal as possible for 5 days. If you need help getting started, check out my guide, How to Use MyFitnessPal.

Once your 5 days of logging are complete, send me an email that you are ready to go!

If I don't hear from you after a week of receiving your new client intake form, expect to hear from me. However, without an accurate food log (i.e. eat all the good, the bad, and the shit you normally do), I cannot create an accurate plan for you. The important thing - BE HONEST. You will only cheat yourself if you don't.

Have questions? Send me an email anytime.

lisa@lisadesilet.com