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1 About You
2 Habits
3 Food
4 Body

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


This questionnaire is ONLY for clients who have purchased customized meal plans or online coaching.


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.

*First Nameyour full name
*Last Nameyour full name
*NOTE: FIRST NAME, LAST NAME, AND EMAIL MUST MATCH YOUR PURCHASE ORDER.
Instagram Handleyour full name
Cityyour full name
State
Country
*Sex
*Age
*Height
*Current Weight
*Goal Weight
*Have you ever experienced an eating disorder?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. Please note, a meal plan doesn’t need to mean “diet”. It can be written at maintenance calories.
*Rate of Weight Loss
Comment on rate of weight loss.
*Have your ever been diagnosed with any hormonal issues?
Describe any hormonal issues.
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*Please indicate if you currently have any of the following medical conditions.
*Please indicate if you have a genetic or family history of any of the following medical conditions.
Comments on medical conditions
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*Are you pregnant or breastfeeding?
If breastfeeding, approximately how many ounces do you lactate per day?

NOTE: The 4 Week Custom Meal Plan comes with four (4) menus for you to rotate and use as you choose. One (1) menu is meant for one (1) day of meals and you can prep as many days as you wish.

*List 4 meals you typically eat for breakfast:
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*List 4 meals you typically eat for lunch:
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*List 4 meals you typically eat for dinner:
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*Would you like your menus to be similar to what you typically eat?

List up to 5 requested food items or dishes below.
*For any specific brand name products, a picture of the nutrition label containing the (1) calorie, (2) protein, (3) carbohydrate, (4) fiber, and (5) fat content MUST be submitted. Your request WILL NOT be honored without this information.
**Please note that our nutritionists will assess your requests to see if these requests will be a realistic fit within your allotted macro goals.
***Any dish or food item listed may be modified or omitted to fit your macronutrient ratios.

List up to 5 requested food items or dishes here.
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*Do you use a protein supplement?

If YES, please take a picture of the nutrition label of your protein supplement. This should include: (1) the name of the protein supplement (2) calorie, (3) protein, (4) carbohydrate, (5) fiber, and (6) fat content.

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*Do you use any other supplements (i.e. BCAAs, protein bars, pre-workout, fish oil, benefiber, etc)?

If YES, please take a picture of the nutrition label of any supplement you use. If applicable, this should include: (1) the name of the supplement (2) calorie, (3) protein, (4) carbohydrate, (5) fiber, and (6) fat content.

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*Do you want a meal plan based on convenience or variety?
*How many meals can you reasonably fit into your day?
Comment on the number of meals you can reasonably fit into your day.
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*What time of day do you workout?
*Do you have any experience with weight training?
*Do you have a gym membership?
*Do you smoke?
What are your weaknesses when it comes to proper diet and nutrition?
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*How many days a week can you CONSISTENTLY workout?
*How many minutes can you commit to each workout session?
*Describe your typical daily activity (outside of working out). Are you seated and sedentary? Are you on your feet?more details
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*What areas would you like to improve on your physique?more details
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*Describe your overall goal and typical physique:
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Choose your program:
*How did you hear about Gauge Girl Training?
*Is this your first time working with Gauge Girl Training?
*Check any ALLERGIES you have:
Other Allergies:
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*What best describes your eating style? Check all that apply:

Paleo: A paleo eating style is gluten free, grain free, lactose free, dairy free, soy free, legume free, and artificial sweetener free. There is not added benefit of this style of eating over another unless you have these specific food intolerances or if you are seeking to minimize inflammation from processed foods.

Paleo + Gluten Free Grains: This style is similar to paleo, but includes gluten free grains like rice (white, brown, wild), gluten free oats, quinoa, corn, amaranth, buckwheat, millet, sorgum, and teff. You enjoy real whole foods but do not have any sensitivites to grains and enjoy including them in your meals.

Clean Eating: Clean eating is about eating real whole foods that are minimally processed.This style of eating typically eats 3-6 times a day with a protein and carb with each meal and about 2-3 servings of fat per day.

Diabetic: A diabetic-friendly meal plan is designed to maintain healthy blood sugar levels. This style of eating tends to minimize carbohydrates, saturated fats, and sodium levels.

Pescatarian: A pescatarian style of eating tends to be higher in omega-3 fatty acids from fish for a heart healthy nutrition approach. This excludes chicken, turkey, pork, and red meat. This style of eating includes seafood, eggs, and dairy.

Flexitarian: This emerging style of eating is for those who want to be more plant based overall, but are willing to include things like chicken and fish when needed for the convenience of hitting their protein macros. There is no defined food list, but this is for those to want to be more intentional about eating plant based food choices when they are able to.

Low Carb High Fat: This style of eating is not necessarily defined by macro ratios but tends to be high in fat, moderate in protein, and moderate to moderately low in starchy carbs.

Keto: Keto is a high fat, low carb protocol designed to support improving insulin reistance. This protocol is 70-75% fat, 20-25% protein, and 5% net carbs.

Vegetarian: A vegerarian lifestyle excludes eating meat and  seafoo but allows dairy and eggs.

Vegan: A vegan lifestyle excludes eating meat, seafood, dairy, and eggs and focuses more on using soley plant based ingredients for ones nutritional needs.

Intermittent Fasting: This style of eating has prolonged periods of fasting and concentrated windows of eating. A typical IF protocol is 16:8 where one fasts for 16 hours and eats within an 8 hour period.

No Preference: No eating style is preferred over another. This client will be recommended an approprate eating style.

    *Do you have experience calorie counting?
    *Do you have experience tracking macros?
    If yes, what are your current macros?
    *Do you mind eating the same protein and vegetables at both lunch and dinner?
    *Would you like to have any of your menus to contain the same meal for both lunch and dinner?
    *What style of macros works best for you?
    Other:

    Menus/Food Style

    *Please note we may not be able to honor every request.

    *Breakfast:I like these types of breakfasts.
    Other things you like for breakfast not listed
    *Lunch:I like these types of lunches.
    Other things you like for lunch not listed
    *Dinner:I like these types of dinners.
    Other things you like for dinner not listed

    What do you want in your meal plan?

    *No means you will not eat this food. 

    **Yes means you can eat this food and this preference is ok to use in your meal plan


    *Protein for my Meal Plan:

    Protein for my meal plan
    Yes**No*
    Ahi Tuna
    Bacon
    Beef Jerky
    Beyond Meat Products
    Bison
    Black Bean Spaghetti Pasta
    Built Bars
    Cod
    Chicken
    Chickpea Pasta
    Chicken Sausage
    Collagen Peptides
    Cottage Cheese
    Dairy
    Deli Style Meat
    Edamame
    Edamame Pasta
    Egg White Protein Powder
    Egg Whites
    Eggs
    Eggs are part of a recipe (i.e. pancakes)
    Epic Bars
    Greek Yogurt
    Hemp Protein
    Lamb
    Lamb Chop
    Mahi Mahi
    Meat Alternatives
    Micellar Casein
    Milk Protein
    Mung Bean Pasta
    Mung Bean Sprouts
    PB2 Powder
    Pea Protein
    Pepperoni
    Pork (in general)
    Pork Sausage
    Pork Tenderloin
    Protein Bars
    Protein Pancakes (homemade)
    Protein Shakes
    Prosciutto
    Quest Bars
    Red Meat (Beef)
    Rice Protein
    Rx Bars
    Salami
    Salmon
    Scallops
    Seitan
    Sea Bass
    Shrimp
    Smoked Salmon
    Smoothies
    Soy
    Soy Protein
    Spirulina Powder
    Tofu
    Tempeh
    Tilapia
    Tuna
    Turkey
    Turkey Bacon
    Turkey Jerky
    Turkey Sausage
    Whey Protein
    Yogurt (regular)
    Yogurt (almond milk)
    Yogurt (coconut milk)

    What do you want in your meal plan?

    *No means you will not eat this food. 

    **Yes means you can eat this food and this preference is ok to use in your meal plan


    *Fats for my Meal Plan:

    Fats for my meal plan
    Yes**No*
    Almond Butter
    Almonds
    Almond Milk
    Avocado
    Avocado Oil
    Butter
    Blue Cheese
    Brazil Nuts
    Cacao Nibs
    Cashews
    Cashew Butter
    Cashew Milk
    Cheddar Cheese
    Cheese (regular)
    Cheese (vegan)
    Chia Seeds
    Coconut Manna (Butter)
    Coconut Milk
    Coconut Oil
    Cream Cheese
    Feta Cheese
    Flax Seeds
    Ghee
    Goat Cheese
    Gorgonzola Cheese
    Half and Half
    Heavy Cream
    Hemp Seeds
    Hummus
    Macadamia Nuts
    Mayonnaise
    MCT Oil
    Milk, 1%
    Milk, 2%
    Milk, Skim
    Milk, Whole
    Mozzarella Cheese
    Oat Milk
    Olive Oil
    Olives
    Parmesan
    PB2 Powder
    Peanut Butter
    Peanuts
    Pecans
    Pesto Sauce
    Pine Nuts
    Pistachios
    Pumpkin Seeds
    Provolone Cheese
    Sesame Oil
    Sesame Seeds
    Shredded Coconut
    Sour Cream
    Soy Milk
    String Cheese
    Sunflower Seeds
    Sunflower Oil
    Tallow
    Vegetable Oil
    Walnuts

    What do you want in your meal plan?

    *No means you will not eat this food. 

    **Yes means you can eat this food and this preference is ok to use in your meal plan


    *(Carbs) Starches for my Meal Plan:

    Carbs/Starches for my Meal Plan:
    Yes**No*
    Acorn Squash
    Almond Flour
    Almond Flour Tortillas
    Apple Sauce (Unsweetened)
    Beets
    Black Beans
    Brown Rice
    Butternut Squash
    Cannellini Beans
    Chickpeas (Garbanzo Beans)
    Cinnamon
    Cocoa Powder
    Coconut Aminos
    Coconut Flour
    Corn
    Corn Tortillas
    Couscous
    English Muffins
    Ezekiel Bread
    Garlic
    Gluten Free Bread
    Gluten Free Oatmeal
    Gluten Free Pasta
    Granola
    Honey
    Hot Sauce
    Instant Oatmeal
    Keto-Friendly Bread
    Kidney Beans
    Lentils
    Marinara Sauce
    Matcha Powder
    Oatmeal Flour
    Oats
    Panko Crumbs
    Pinto Beans
    Pitas
    Polenta
    Popcorn
    Protein Pancake Mix (Kodiak Cakes)
    Pumpkin Puree
    Quinoa
    Quinoa Bread
    Red Lentil Pasta
    Red Potatoes
    Rice Cakes
    Rx Bars
    Siete Tortillas (Almond Flour Tortillas)
    Soy Sauce
    Spaghetti Squash
    Sriracha
    Steel Cut Oats
    Sweet Potato Chips
    Sweet Potato Fries
    Sweet Potatoes
    Tomato Sauce
    Wheat Flour Tortillas
    White Bread
    White Rice
    Whole Wheat Bagel
    Whole Wheat Bread
    Whole Wheat Pasta
    Wild Rice

    What do you want in your meal plan?

    *No means you will not eat this food. 

    **Yes means you can eat this food and this preference is ok to use in your meal plan


    *(Carbs) Veggies + Fruits for my Meal Plan:

    Carbs/Veggies and Fruits for my Meal Plan:
    Yes**No*
    Apples
    Artichokes
    Arugula
    Asparagus
    Banana
    Banana Chips
    Basil
    Bell Peppers
    Blackberries
    Blueberries
    Bok Choy
    Broccoli
    Brussels Sprouts
    Cabbage
    Cantaloupe
    Capers
    Carrots
    Cauliflower
    Celery
    Cilantro
    Collard Green Leaves
    Craisins
    Cucumber
    Dates
    Eggplant
    Grapefruit
    Grapes
    Honeydew
    Iceberg Lettuce
    Jalapeno Peppers
    Kale
    Mango
    Mixed Berries
    Mushrooms
    Onions
    Oranges
    Peaches
    Pears
    Peas
    Pineapple
    Plantains
    Pomegranate Seeds
    Radishes
    Raisins
    Raspberries
    Romaine Lettuce
    Salsa
    Snow Peas
    Spinach
    Strawberries
    String Beans
    Sun-Dried Tomatoes
    Tomatoes
    Turnips
    Watermelon
    Zucchini

    What do you want in your meal plan?

    *No means you do not want this with your food. 

    **Yes means you want this with your food and this preference is ok to use in your meal plan


    *Seasonings/Condiments for my meal plan:

    Carbs/Veggies and Fruits for my Meal Plan:
    Yes**No*
    Apple Cider Vinegar
    Balsamic Vinegar
    Lemon Juice
    Lime Juice
    Liquid Aminos
    Old Bay Seasoning
    Stevia
    *What exercises can you NOT perform?

    Picture Submission Requirements: ONLY SUBMIT 3 PICTURES. (Preferably in a bathing suit, but If you are not comfortable being photographed in a bathing suit, a sports bra and shorts is acceptable). 

    • In a full length mirror (if taking pictures yourself) or have someone take them for you 
    • Good Lighting 
    • Minimal clutter in the background
    • Use same outfit every week during our check-ins.

    Please take the images from the following angles: FRONT, SIDE and BACK:

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    Commentsmore details
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    Please review your answers for accuracy. Any dietary or training needs NOT mentioned will NOT be accounted for in your program UNLESS THEY ARE EXPRESSLY WRITTEN.

    *Yes I have reviewed my answers and understand that the program CANNOT be re-adjusted to accommodate for changes after hitting "SUBMIT."
    *What is your preferred method of contact?

    Please note: Programs are sent out within 5-7 business days (weekends, holidays not included) after your phone call.

    *What is the best phone number to reach you at?
    What is the best time to reach you?
    If you chose "other," please provide that method of contact here
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