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Basic Membership Monthly Evaluation Form

Before you begin, please note that you must be 18 years old or older.


You should consult your physician or other health care professional before starting this or any other weight loss program to determine if it is right for your needs.


This form is ONLY for basic GGT Lifeline Members who have followed their most recent set of macros for AT LEAST one month.

*PLEASE NOTE: Evaluation CANNOT be performed without compliance with the recommended macros.

GENERAL INFO

*First Name
*Last Name
Phone
*NOTE: FIRST NAME, LAST NAME, AND EMAIL MUST MATCH YOUR PURCHASE ORDER.
Gender
*Age
*Birthdate

Height

Weight

*Starting WeightIndicate Pounds or Kilograms
*Current WeightIndicate Pounds or Kilograms
*Goal WeightIndicate Pounds or Kilograms
Rate of Weight Loss*:
Other
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*Please note that the nutrition team will assess whether or not this is safe for you. Calorie deficit may be adjusted to ensure a safe calorie level


**If your goal weight is significantly LESS than your current weight, this option may not be right for you.



Date of Last Macro Evaluation

ACTIVITY FACTOR

*Has your overall activity level changed since your last evaluation? If yes, please describe below.
Describe here.
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*How many days a week are you planning on working out?
*Select which best describes your level of activity outside of working out:

MACRONUTRIENT INFORMATION

*Please provide your previous macronutrient breakdown below:

Calories (kcal)
Protein (g)
Carbs (g)
Fat (g)
*Are you satisfied with your current calorie level? Explain below.
Explain here.
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*Are you satisfied with your current style of macros? Explain below.
Explain here.
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*Would you like to change your current style of macros?

If yes, please select the style of macros you would prefer:

Other
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*How consistently have you followed your recommended macronutrient ratios?
Feel free to elaborate!
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*How would you describe your level of hunger while following your recommended macronutrient ratios?

PROGRESS INFORMATION

How do you feel about your overall progress?
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*Have you noticed any changes in the way your clothes fit? If yes, please describe below.
Describe here.
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*Have you noticed any changes in strength and/or endurance? If yes, please describe below.
Describe here.
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*Have you noticed any changes in muscle definition? If yes, please describe below.
Describe here.
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*Have you been taking progress pictures?

NOTE: MUST BE IN JPG or PNG FORMAT (with a max file size of 8000kb each image)

If YES, please 3 ATTACH images: front, back and/or side (preferably front and back). To be in either a bathing suit or a sports bra and shorts.

Uploads
cloud_uploadUpload

ADDITIONAL INFO

*Have you ever been diagnosed with any hormonal issues?

*Are you pregnant or breastfeeding?
If breastfeeding, approximately how many ounces do you lactate per day?
If pregnant, how far along are you?

BODY TYPE

For a free body type assessments please email bodytype@gaugegirltraining.com

ACKNOWLEDGEMENT: Yes, I have reviewed my answers and understand that the program CANNOT be re-adjusted to accommodate for changes after hitting "SUBMIT."
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