Fix My Diet Assessment "*" indicates required fields Step 1 of 4 25% Name* First Last Email* Phone*Age* Height* Current Weight* What is your neurotype? If you don't know, please complete the assessment here -https://neurotypetraining.com/personality-diet-assessment-login/ Do you have any medical conditions you wish to disclose? (I.E. diabetes, hypothyroid, high cholesterol, etc) Goal Review SectionWhat is your primary goal?* Weight Loss (more than 20 pounds to lose) Performance (optimize my performance for a sport) Build Muscle (build muscle to improve body composition. Maintenance+ cals required) Health/Longevity (I want to live my life the best way possible. I want to feel my best!) Aesthetics (I just want to look good naked! I have an event coming up I want to prepare for) Other Daily Routine How many steps do you take a day? If you don't know put N/A* Metabolic Assessment How would you rate your daily energy levels?*Please Select1 Very low energy2345678910 Very high energyHow would you rate your daily stress levels?*Please Select1 No stress at all2345678910 Very high levels of stressOn average, how many hours of sleep do you get each night?* 6 or less hours 7 or less hours of sleep per night 7-9 hours of sleep per night Other How would you rate the quality of your sleep?*Please Select1 Wake up several times a night/wake up tired2345678910 Sleep like a rock/Very high energy upon wakingDo you have a sleep routine (I.e. go to bed and wake up at generally the same time each day)* How active are you?* Very sedentary (no exercise routine/desk job) Sedentary (no exercise routine/minimally active during the day) Moderately active (exercise 1-2 days per week/about 5k steps a day) Active (consistent exercise 2-3 days per week/active throughout the day) Highly active (physically demanding job/consistent exercise or consistent exercise 4-5 days per week and 8-10k steps/day) Other Diet HistoryWhat diets have you tried in the past?* How many calories on average are you consuming? If you don't know, type N/A.* How would you rate your protein intake?*Please Select1 Very low - rarely consume protein2345678910 Excellent - consume protein 3-4 times per dayHow would you rate your food quality?*Please Select1 Poor - very little veggies or whole foods2345678910 Lots of veggies and minimal processed foodsHow many alcoholic drinks do you consume per week?* TrainingPlease describe your current workout/training program*On average how intense are your workouts?*Please Select1 Not very intense. Can easily hold a conversation with a friend2345 Super intense. Heavy weights or high intensity conditioningReadinessPlease put a check mark next to all that apply* I have a food scale I have weighed out my food portions before I am currently weighing out my food portions more than 70% of the time. I am willing to weigh out my food portions I have tracked my food in an app such as my fitness pal, spark people, carb counter, excel, etc I am willing to track my food. I rely primarily on pre-made meals. I am willing to cook more at home. After you hit submit you will be prompted to schedule a call to review your results.
