Initial Client Form Name* First Last Today's Date* Date Format: MM slash DD slash YYYY Phone*Email* DOB* Date Format: MM slash DD slash YYYY Occupation / Do you work full time?*THESE NEXT QUESTIONS HELP ME DEVELOP THE EXACT NUTRITION & FITNESS PLAN TO GET YOU REACHING YOUR GOALS QUICKLY! Let's get serious about hitting your goals!Your Age*Weight (kgs)*Height (cms)*Chest Measurement (cms)*Neck Measurement (cms)*Waist Measurement - navel (cm)*Hip Measurement - inline with pubic bone (cm)*Thigh Measurement - Left (cm)*Thigh Measurement - Right (cm)*Select your activity level* Sedentary (office job) Light exercise (1-2 times/week) Moderate exercise (3-5 times/week) Heavy exercise (6-7 times/week) Athlete (2 x day) What type of fitness are you currently doing?* Home program - body weight Home program - dumbbells, kettlebells, fit ball, Gym program - access to machines and free weights Pilates / Yoga Walking None Which FIT BODY Program have you purchased?* 28 Day Lean Up 6 Week Challenge 6 Week SHRED, SCULPT, BOOTY 8 Week Metabolic Repair 12 Week LIFT 6 Week Nutrition Meal Plan Only Other What is your number 1 goal right now?*Why is this your goal?*What realistic time frame do you want to reach these goals?*What is the biggest thing holding you back right now?*Apart from your goal, what else would you like to get out of this program? Improving energy Changing body shape Learning what to eat Understanding macros and calories Reducing snacking and cravings Other Allergies/Dietary RestrictionsList all the foods that you DO NOT eat.List 10 of your favourite foods + Any foods you crave?What TIME is your FIRST meal and what do you usually have?What time is your NEXT meal and what do you usually have?What time is your NEXT meal and what do you usually have?What time is your NEXT meal and what do you usually have?What time is your LAST meal and what do you usually have?How much water do you drink every day?Are you medically well? Please mention any medical conditions you may have. ie: diabetes, high blood pressure etc.I am not a dietician nor do I diagnose medical illnesses/injuries. I am a qualified Fitness Nutrition Coach and Sports Nutritionist. Please ensure you are cleared to begin working with me by your medical professional. TYPE in the box below - Ready to startDesired Start Date (If ASAP please allow 4-5 days to customise the program)Anything else you want to add?Upload your Front Starting PictureUpload your Back Starting PictureUpload your Side Starting PictureConsent* I agree to Nikki Auckland/FIT BODY BY NIKKI using my information to develop a program for me. No images or information will be publicly shared without my consent. This iframe contains the logic required to handle Ajax powered Gravity Forms.