Name: *
Email Address: *
Current Weight: *
Height: *
Gender: *
Male Female
Age: *
Must be 18 or older to fill out this form. For minors, please contact us directly.
How would you describe yourself? *
Please Select... A regular person or amateur athlete An elite athlete A physique competitor, professional athlete, or model
Select A Nutrition Goal: *
Please Select... Lose Weight - I'd like to lose at least 10 to 15 pounds (or more) Build Muscle - I'd like to build muscle and increase overall body weight Athletic Performance - I want optimal nutrition to support long and intense athletic training (minimal to no weight change desired) Body Recomposition - I want to lose less than 10 to 15 pounds of body fat, while simultaneously building muscle Improve Health - I want to improve my nutrition and overall health, while maintaining my current weight.
Goal Weight:
Goal Completion Date:
Weekly Purposeful Exercise: *
Please Select... Very Light - Almost no purposeful exercise Light - 1 to 3 hours of gentle to moderate exercise Moderate - 3 to 4 hours of moderate exercise Intense - 4 to 6 hours of moderate to strenuous exercise Very Intense - 7+ hours of strenuous exercise
Daily Activity Level Excluding Purposeful Exercise: *
Please Select... Very Light - Sitting most of the day (example: desk job) Light - A mix of sitting, standing, and light activity (example: teacher) Moderate - Continuous gentle to moderate activity (example: restaurant server) Heavy - Strenuous activity throughout the day (example: construction worker)
Dietary Preference: *
Please Select... Anything - No major preferences or restrictions, will eat practically anything Mediterranean - Features plant foods, healthy fats, and moderate amounts of lean protein Paleo - Emphasizes meats, vegetables, and healthy fats Vegetarian - A plant-based diet, plus small amounts of eggs and dairy Ketogenic - A high-fat, very-low carbohydrate diet Fully Plant-Based - All plant-based foods, no animal products of any kind
Do you currently track calories or macros? If so, what is your daily average intake?
How many Meals Per Day do you prefer to eat (including snacks):
Would you like us to know anything else about your way of eating or your nutrition goals?
For example, 'My body responds well to low-carb eating,' or 'I can not eat large amounts of protein.'
Please Confirm:
I understand that the dietary advice provided by Heavy Metal Fitness (including macro and portion recommendations) is not to be considered medical advice. For specific nutritional health needs, I acknowledge that I need to consult my medical doctor.
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