Jordan Ashleigh | Client Questionnaire
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Client Questionnaire

Please answer the following questions to the best of your ability. The more detailed information you can provide, the better, as everything is individually customized.


First & Last Name*
Verify Package*





What are short term goals you are looking to accomplish with this plan?


What are long term goals you are looking to accomplish with this plan?




Provide a detailed description of an average day of your current diet. If you do not know this, please track what you eat for a few days. You can use the app MyFitnessPal to do this.


If you know your current macronutrient intake, please provide the amount of fats/carbs/proteins:


If you know how many calories you're in taking, how long have you been eating this amount of food (i.e. if you're trying to lose weight, how long have you been "dieting")


How many "cheat/treat" meals are you having a week?


How have your weight loss and energy levels been at this intake?


You must be willing to learn how to track your macros, is this something you think will be an issue?



What's your daily activity like?

How many days a week do you work out?




Please list an example of your workout routine?

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7


How much cardio are you doing?
Which cardio seems to work best for you?
What time of day do you workout?




If you have or in the past have struggled with body image issues, fear of consuming certain foods or gaining weight please share that with me as well. Health is not just about the body, but the mind as well!

Please list any additional information you'd like to share with me that you feel would be relevant to your program design.

Please select all the food items you Do Not want included in your meal plan...