NUTRITION COACHING

Jaxon Burton - MNU Certified Nutritionist

After years of working with a variety of people I have come to realise that the greatest challenge that is stopping you from achieving your physique, health and performance goals is largely nutrition related.

Now, I own a gym, and still place a huge amount of emphasis on strength and cardiovascular training and the benefits these produce.

But there is no denying the huge role a smart and structured nutrition strategy plays.

THIS IS ONLY FOR YOU IF...

You are not looking for a one-off 'meal plan'. - I focus on ongoing coaching to take you from where you are now to where you want to be... it's an education. Not a quick fix.
You are wanting to achieve results in the most evidence based and effective way - without fad diets, juice diets, detoxes, hair tests or any other fitness industry BS.
You understand the importance of exercise and specifically a strength training program and how this is essential to your results with me.
You are ready to commit a minumum of 12 weeks.

From here we need as much detail as possible.

In order to undertake any service with JaxFit Nutrition Coaching I ask all potential clients to complete the following Pre-Consultation Form, in detail, so I can get a better insight into you, your background and your goals.

Once completed, please click 'submit'.

I will endeavor to get back to you with my Service Brochure, which lists all of my services with associated costs within 3–5 working days. If required, I can also personally recommend a service based on your individual goals and budget…

I'm super excited for you to get started and begin this journey!

Talk soon!

Jax.

Client Details

Name

First Name

Last Name

Address

Where are you geographically based?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone

(###)

###

####

Age

Height

Weight

Current Body Fat Percentage

If known, measured by callipers at 4 sites within the last 4 weeks

30% & over

20-30%

15-20%

10-15%

8-10%

7-8%

5-7%

Level Of Activity

Occupation

About You (Lifestyle, Hobbies, Illnesses, Dietary Needs – NOT your goals)

Number 1 Health & Fitness Goal

Please list all of your goals in order of importance.

Please expand on your goals

Quantify your targets/expectations/timescale/previous experiences etc.

Why is this important to you?

What is going to keep you going when things get tough and you feel like throwing in the towel?

How many meals per day do you currently eat on average?

Do you eat very similar meals each day or are they more varied/ erratic:?

e.g. bought packaged goods etc

If you are able, please write down a TYPICAL day's food and drink.

List with titles: Breakfast, Snack, Lunch, Snack, Dinner, Snack.

What is this typical day’s eating trying to achieve?

Do you currently use any supplements or medications?

If yes please list their details

Please list (with approximate dates) any supplements and in particular, medications (including antibiotics) you have used in the last year

In very simple, practical terms, what is it that you need to do to achieve your goals?

i.e. what can we do for you?

The different services I offer vary in terms of the level of support, time and client effort required. To better help advise you on the most appropriate and effective service for your individual goals, please indicate the budget most applicable to your current situation.

Please state your dietary requirements

(i.e. any foods you can/will not eat)

If we end up working together, what does success look like to you in 3 months, 6 months and 12 months?

Please list in detail your current training.

Type of exercise, duration, frequency and on what days of the week.

Please detail information relating to menstrual cycle length, frequency or if you are postmenopausal:

Have you previously sought dietary advice or followed a diet protocol?

Do you own digital bathroom scales?

Yes

Do you own digital kitchen scales?

Yes

Would you be willing to provide a testimonial and/or before and after photos (if applicable) for the Jax Fitness website?

Yes

Possibly

Do you have access to Skype/Facetime should your consultation need to be remote?

Yes

How did you come across Jax Fitness? e.g. Newspaper, Magazine, TV, Google search, Personal referral etc

If you used a search engine to find us, we would love to know what phrase you typed in that brought us up!

Anything else you would like to discuss or feel we should know?