Fillable Members Consultation Package www.ExceenNutrition.com Hello & Welcome!

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Members Consultation Package
www.ExceenNutrition.com
Hello & Welcome!
Thank you for choosing Exceed Nutrition and working with myself. To get things rolling I would be
grateful if you could fill in the information asked below. This helps me get a good understanding
of your current fitness level, goals, diet and generally a bit about you. The more information you
can supply the better I can make our system more personalised for you and in order to create a
great nutrition plan.
All information given is kept confidential and I request that the information supplied is used
solely by you and is not shared.
The consultation is split into four sections; Nutrition Analysis, Physical Training Analysis, Pictures
& Food Diary. Please fill in all sections before returning the package. You may wish to print this
off to complete it; I can supply an address to send it to if required. Answer the questions
truthfully and accurately.
There is a goal-setting question for each section. Adding facts and figures to this goal will help
you track your progress and evaluate the results. We can also review your goals and provide the
relevant and correct advice.
Use the SMART principle when setting goals. This is;
Specific – What exactly do you want to achieve using this plan? E.g. 6lb weight loss
Measurable – What methods can you use to record progress? E.g. scale weight/Mirror
Action – What do you believe is required to achieve your goal? E.g. better food choices
Realistic – Can you achieve this goal, even with help? What might hold you back?
Time – By when do you want to achieve your goal?
Please return this Consultation Package to: Ru.Anderson01@gmail.com
Members Consultation Package
www.ExceedNutrition.com
PERSONAL DETAILS
CONTACT INFORMATION
FIRST NAME LAST NAME
STREET ADDRESS STREET ADDRESS LINE 2
CITY POST CODE
PHONE NUMBER EMAIL ADDRESS
AGE SCALE WEIGHT HEIGHT
HOW DID YOU HEAR ABOUT EXCEED NUTRITION?
HOW ARE YOU FEELING RIGHT THIS MINUTE?
HOW HEALTHY DO YOU CURRENTLY FEEL?
PLEASE DESCRIBE YOUR CURRENT NUTRITION KNOWLEDGE LEVEL
Members Consultation Package
www.ExceedNutrition.com
SECTION 1 - NUTRITION ANALYSIS
This section looks at your current diet and eating habits. Please be truthful and
accurate with your answers.
1. Please describe any previous diets that you have followed, how successful they were and
how you felt during them. E.g. Paleo, low carb, weight watchers, intermittent fasting etc.
2. Please describe what your favourite healthy food choices are. Include what your favourite
protein, carbohydrate and fat source is E.g. Tuna, Pasta and Eggs.
3. Please highlight any foods you do NOT like:
4. Please describe any allergies and/or intolerances you may have:
5. Are there any other foods to which you’re particulary sensitive (i.e., which cause excessive
gas, bloating, stuffiness, or congensation)?
6. Please describe your current supplements (i.e protein powder, creatine, vitamins/minerals)
intake. If you do not currently take supplements, are you willing to introduce some beneficial
ones?
Members Consultation Package
www.ExceedNutrition.com
7. What are your current weekly budget requirements for food shopping and supplements?
8. Please describe your goals in relation to a nutrition program. Remember to use the SMART
(page 2) principle when setting these.
9. To date, what is the main factor(s) holding you back from achieving your nutrition goals?
10. Please provide a timetable with your most normal daily schedule listing the time you wake
up, work and have breaks, eat, work out and go to sleep:
11. Do you have any weekly activities that you undertake e.g. Football every Tuesday night?
12. Do you currently take any medication?
Members Consultation Package
www.ExceedNutrition.com
13. How do you feel after eating a large carbohydrate meal e.g. bowl of pasta?
14. Do you enjoy eating white or red meats the most?
15. Do you get food cravings, if so, what for?
16 . Do you ever binge eat?
17. Would you say you have a good relationship with food?
SECTION 2 - PHYSICAL ANALYSIS
Physical training covers all aspects of fitness you conduct.
1. Please describe what current training/sport you do (if applicable) E.g. Weight Training/
Cardiovascular exercise/MMA/rugby
2. Please describe any current or previous injuries you have obtained that may affect your
physical training;
Members Consultation Package
www.ExceedNutrition.com
3. Please provide a chart with the type of exercise you normally perform each day with the
duration, eg. Monday - Weights (evening) - 1.5h; Tuesday - Cardio (lunch time) 30m...
4. Please submit your current exercise regimen along with this consultation package (type it
up or attach to the Email along with consultation):
5. Please describe your goals in relation to a physical training program. Remember to use the
SMART (page 1) principle when setting these;
6. To date, what is the main factor(s) holding you back from achieving your training goals?
Members Consultation Package
www.ExceedNutrition.com
7. Exercise Information - Please rate the ability in the following exercises (check the box that
corresponds with your ability; 1- UNFAMILIR; 2-NOVICE; 3-INTERMEDIATE; 4-ADVANCED):
1 2 3 4
BARBELL SQUATS
BARBELL DEADLIFT
BARBELL BENCH
PRESS
BENT-OVER BARBELL
ROW
BARBELL SHOULDER
PRESS
PULL-UP
BARBELL HACK
SQUAT
OLYMPIC MOVEMENTS
1 2 3 4
SNATCH
CLEAN
Members Consultation Package
www.ExceedNutrition.com
SECTION 3 - PICTURES
Up to date pictures are extremely important for creating tailored nutrition plans. This allows
me to see your current body type, potential genetics, hormonal profile, postural analysis,
body fat distribution and so much more. Please do not skip this section, it can make a huge
difference in the output of your nutrition plan which can drastically affect results.
It is best to ask someone to take these pictures to ensure good quality and full body shots. A
front, side and rear picture is ideal, with men wearing only shorts and women wearing gym vest
and shorts.
All information supplied is kept confidential and will never be shared or passed on.
Please attach your pictures to the Email along with the consultation package.
Motivational Pictures
Most people have a picture of the ideal body they would like to achieve. If you can attach this
picture(s) with the Email it is great for setting goals and motivation. We can then discuss the
strategies and techniques to be used to achieve this look, then start applying the best processes
to get you on the right track. This is also great for setting long term goals and realistic time
frames in order to complete them. If you are on the High Performance Living coaching program,
this will allow us to program a long term plan and set time frames for each stage.
Members Consultation Package
www.ExceedNutrition.com
SECTION 4 - FOOD DIARY
It is essential to look at your current nutrition in order to maximize the help I can provide you
with and to get the correct starting point for your nutrition plan. By looking at your current diet I
will be able to see your current nutrition lifestyle and find any problems within it. I can then
tailor your new plan to remove these problems while still respecting your lifestyle so we can
achieve your results while making the integration process as easy as possible.
Please detail all food, liquids and supplements that you consume for at least the next 3 days.
Feel free to continue this for as long as required to show me a good representation of your eating
habits. Record this as and when you eat it, stating the time, food items & rough serving size for
each item. There is also a comments box that you should use to describe why you ate this and
how you felt after from eating it.
DAY
TIME/MEAL FOOD AMOUNT COMMENTS
Members Consultation Package
www.ExceedNutrition.com
DAY
TIME/MEAL FOOD AMOUNT COMMENTS
DAY
TIME/MEAL FOOD AMOUNT COMMENTS
Members Consultation Package
www.ExceedNutrition.com
FINALLY
Thank you for completing the consultation process, this greatly benefits me for creating your
nutrition plan, getting to know you and provide you with the best advice and support. It has
encouraged you to think hard about your physique goals, were you currently stand in achieving
these and how to achieve them. By doing so you have already completed one of the main hurdles
that face people when trying to achieve their ideal body and health.
Please send the completed package back to me once all sections have been completed. I will
review the package and aim to have your personalised nutrition plan back to you within 5-7
working days.
Thanks
Ru Anderson
Owner of Exceed Nutrition
Members Consultation Package
www.ExceedNutrition.com
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Completed 22 February 2021

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