Questionnaire - Kate Dalebout

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Please start by completing the following questionnaire

Hey, Whats with all the questions?

In order for me to help you succeed, I’ll need to understand more about who I am working with. Many of our struggles with fitness and nutrition go beyond a lack of willpower or commitment, so the more details I know about you, the better I can understand who you are and how to help you best.

Please fill out the form below

It’s really easy.

First Name

Last Name

Height

Current Weight

Goal Weight

Age

Gender

Male Female

Out of the following body descriptions, which one would you say best describes you? (Don't stress too much about this, just choose which one you think fits best)!

Ectomorph: Naturally thin, usually taller with long limbs Endomorph: More of a broad physique with thicker limbs Mesomorph: Naturally more muscular and athletic

How would you describe your daily activity?

Sedentary: little to no activity, spend most of the day sitting Light activity: work out a couple of times a week at moderate intensity plus light work around the house Moderately Active: work out 3-5 X a week fairly vigorously + activity around the house Very Active: workout 6-7 days a week fairly vigorously + mostly standing/active during the day

Are you pregnant?

Yes No

Did you have a baby within the last 3 months?

Yes No

Are you breastfeeding?

Yes No

Have you ever counted macros before?

Yes No

What are your fitness goals?

What do you do for a living?

Do you have any health problems that may interfere with this?

What personal goals do you have that you want to accomplish?

What is your motivation for choosing to count macros? What do you hope to learn through the process?

How many days per week are you currently working out?

What kind of exercise do you do? weightlifting, crossfit, bodybuilding, whatever you feel like that day at the gym etc

Dieting History: Have you been intentionally trying to lose weight/or gain weight for awhile? If so, what methods have you used? What has worked for you in the past and what hasn't, do you feel like you have a healthy or unhealthy relationship with food?

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Hey, Whats with all the questions?

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