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A clean and sanitized gym that is designed only for
1-2:1 training sessions.
(Following Covid Restriction Protocols)

Nutritional
Intake Form

Start your transformation today!

Your full name

Birthdate

Email address

Phone Number

Goals

What are your top 3 (or more) health and wellness goals?

What would you like to get out of working with me?

If you could tell me the best way to bring out your best, what would you say?

Current Health Challenges

What challenges are you having in regard to your health and fitness?

Are you engaged in any treatments (conventional or alternative) related to any health challenges or issues? If so, please describe.

What repetitive patterns have you noticed appear again and again in your life when it comes to your diet and health?

Support System and Significant Events

I’d like to know about your current support system. Please share more about the practitioners, medical doctors and specialists, nutritionists, trainers, therapists, naturopaths, friends, and family who support your health and well-being.

Telling me about your past helps put the puzzle pieces of your health/fitness journey together. You do not need to write your life story, but perhaps list a few significant events that you feel are relevant to your health. Do you have any significant life events coming up?

You’re Relationship with Yourself

What is your self-talk like? Do you tend to be kind to yourself or do you tend to be more negative?

What are your beliefs about your ability to transform your body?

How are you at doing what you say you will do?

Lifestyle

What aspects of your home life and environment support your nutrition and fitness efforts?

What aspects detract from your efforts?

What aspects of your work life and environment support your nutrition and fitness?

What aspects of your work life detract from your nutrition and fitness?

What do you do to reduce stress in your life, or to counteract the effects of stress in your life?

Please tell me a little about your interests, hobbies, and passions.

Physical Activity

How often are you physically active, on average, per week?

Describe your current physical activities in terms of frequency, duration, and types.

Do you have any limitations in movement/exercise? Please elaborate.

Diet and Nutrition

Please list typical foods you eat and the times you eat them on a typical day.

Additional beverages (IE: coffee, tea, soft drinks, alcohol):

Please list all supplements and herbs you are currently taking; what you are taking them for; and how long you've been taking them.

Any food you can’t stand?

Foods you can’t do without?

Are you open to trying intermittent fasting?

Sleep and Stress

On average, how many hours per night do you sleep?

What time do you typically go to bed?

What time do you typically wake up?

How well do you sleep each night, such that you feel rested when you wake up? Rate on a scale of 1-5, with 1 being “poorly” and 5 being “excellently.”

How would you rate your current stress level? Rate on a scale of 1-5 with 1 being “low/no stress” and 5 being “highly stressed.”

Concluding Thoughts

What time do you typically wake up?

Contact

Train
with Ted

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Tailored corporate program

Nutritional
Intake Form

Goals

Current Health Challenges

Support System and Significant Events

You’re Relationship with Yourself

Lifestyle

Physical Activity

Diet and Nutrition

Sleep and Stress

Concluding Thoughts

Nutritional
Intake Form

Diet and Nutrition

Physical Activity

Sleep

Concluding Thoughts

Personal Training Questionnaire

Train
with Ted

Contact

Train with Ted

Navigation

Contact

Tailored corporate program

Nutritional Intake Form

Goals

Current Health Challenges

Support System and Significant Events

You’re Relationship with Yourself

Lifestyle

Physical Activity

Diet and Nutrition

Sleep and Stress

Concluding Thoughts

Nutritional Intake Form

Diet and Nutrition

Physical Activity

Sleep

Concluding Thoughts

Personal Training Questionnaire

Train with Ted

Train
with Ted

Nutritional
Intake Form

Nutritional
Intake Form

Train
with Ted