Nutrition Application

    Personal Information

    First Name

    Last Name

    Postal Address

    Email Address

    Contact Number

    Date of Birth

    Health History

    What is your current weight (kg)?

    What is your height (cm)?

    Do you have any of the following medical conditions:
    Please check if any conditions that might apply to you. If your condition is not listed then please check "other".

    DiabetesDigestive problemsIrritable Bowel Syndrome (IBS)Polycystic Ovary Syndrome (PCOS)High Blood PressureOther (please specify)

    Please specify

    Do you have any injuries?
    YesNo

    Please specify

    Do you have any food allergies?
    YesNo

    Please specify

    Are you pregnant or have recently given birth?
    YesNo

    Do you smoke?
    YesNo

    Do you drink alcohol regularly?
    YesNo

    Nutrition History

    What is your current calorie intake?
    Please enter "unknown" if you don't know this information.

    What is your current macronutrient intake (carbohydrates, fat and protein in grams)?
    Please enter "unknown" if you don't know this information.

    Have you tried dieting before?
    YesNo

    What diets have been successful for you and why?

    What diets have NOT been successful for you and why?

    Are you currently adhering to a specific diet?

    Training History

    How many days per week do you currently lift weights?

    How many days per week do you currently do conditioning (cardio)?

    Please choose one of the following boxes to indicate the amount of physical activity (and perceived intensity) you perform on a daily basis:
    Very LowLowModerateActiveVery Active

    Which types of training have you had previous experience with?
    Cardiovascular trainingEndurance trainingStrength trainingHypertrophy trainingFlexibility trainingOther (please specify)

    Goal Setting Information

    How do you perceive your current level of fitness?
    LowAverageGoodHigh

    On a scale of 1 to 10, how happy are you with your current body composition?
    Please enter a value between 1 and 10.

    What are your health and fitness goals?

    What are your body composition goals?

    How many days per week can you dedicate to training and conditioning?
    Please enter a value between 1 and 7.

    Are you prepared track, weigh and measure food to get optimal results?
    YesNo

    Would you prefer your Nutrition Consultation In-Person or Online?
    In-PersonOnline

    Terms and Conditions

    I confirm that by selecting this box I accept the Terms and Conditions laid out by Rachael Fisher trading as Ivy Training (ABN 77 845 396 118).

    To read the terms and conditions please click here.