General Nutrition Consultation Form

Please fill out the following form so we can have an understanding of where you’re at currently. This will give us the information we need to build a custom nutrition plan fit to you. Following this you will proceed to payment instructions, once payment is processed your information will be forwarded and the process has begun. Welcome to the team!

General nutrition Pricing:
Starting at $275.00 Initial plan/process.
$25.00 Weekly payments for updates/support.

Name

First Name

Last Name

Your Current Weight (KG)

Your Age

Please List Any Allergies

E.g. Peanuts, Fish, etc

Food Dislikes

Foods you absolutely can't eat

Food Preferences

List any healthy option foods you like more so. This will help me make a plan you are more likely to enjoy

Current Medication/s

Personal and/or prescribed

Your Goals

Both short term and long term goals

Your Current daily activity level:

Being daily movement/Career demands etc.

Very Low

Low

It's Ok

High

Very High

Please Describe your current training/exercise

e.g. I do 45 minutes of weight training 3 times a week and then i play tennis on weekends.

Please Describe your eating over the last 4 weeks:

This is to give me an estimate on a common day of eating, or highlight any potential eating considerations for each individual.

Where did you hear about Ascend?

Please write below anything else you think i should know:

any considerations or limitations with you or your lifestyle that may have an effect on your eating or should be considered for myself before putting together the best possible plan for you.

Photo requirements

And Lastly please take 3 full body photos. one from the front, one from the side and one from the rear. Please wear underwear in your photos as a minimum or you may cover up but please wear tightly fitting clothes if you do so. Please send directly to ascendnutrition.nz@gmail.com Please note: no images of anyone will be used, released to anyone else, advertised or released publicly without prior permission as this is your personal privacy.

I have sent these photos via email

I will send these within the next 24 hours

General Nutrition Consultation Form

Ascend Nutrition