Apply For All In Curious

A 8-Week Coaching Program

Get the 1-on-1 attention and accountability you need to lose the weight, gain mental clarity, and upgrade your health.

Name *

First

Last

Email *

Your best email so we can send you the zoom link

Phone *

Your cell in case we don't receive email confirmation

Age *

Weight *

Measurements

Chest *

Waist *

Hips *

Neck *

Is it hard for you to lose or gain weight? *

How many hours do you typically sleep a night? *

What is your stress level at (1-10) 10 being the worst? Causes of stress? *

List the following in order of priority, first being the most important: Weight, Energy, Sleep, Social Lifestyle *

Do you have any autoimmune conditions or any other diagnosis? *

What prescription medication/supplements (if any) are you taking? *

What would you like to gain from working with me? *

Nutrition

Have you tried the ketogenic lifestyle? If so, how long? *

What diets have you tried in the past? Any of them successful? *

Do you suffer from any eating disorders or have you in the past? *

Do you have any food triggers (causes you to binge or not adhere to your plan)? *

Do you have any food allergies/intolerances that you are aware of? *

Do you drink soda? If so, how many times a week? *

Do you drink alcohol? If so, how many times a week? What kind of alcohol? *

Is it hard for you to stick to a diet? *

What’s one thing you refuse to give up? *

Do you cook at home /meal prep or eat out? Times a week do you eat out? *

Do you consume any of the following: Dairy, Wheat, Eggs, Soy, Corn, Artificial Sweeteners? *

Do you count calories or track in any way? *

How often do you have a bowel movement? Any issues with constipation/diarrhea? *

What is your main frustration in nutrition? *

Fitness

How many days do you workout? *

How much cardio per week? *

Do you weight train? If so, how many times a week? *

Do you have a gym membership or do you workout at home? *

If you have a program in place, please detail below: *

What do you like to do for movement: Weight training, yoga, pilates, running, etc. *

Do you like working out, if not, why? *

What is your main obstacle in the gym? *

What are you looking to achieve? Weight loss, muscle growth, strength, heart rate conditioning? *

Do you have a fitness tracker of any kind? (Fitbit, Apple Watch, Oura Ring, Etc) *

Do you have any current injuries? Past Injuries? *

Anything else Stephanie should know? *

Disclaimers

Medical Disclaimers

I do not hold a degree in dietetics, medicine, or nutrition. I make no claims to any specialized medical training, nor do I dispense medical advice or prescriptions. This content is not intended to diagnose or treat any diseases. It is intended to be provided for informational, educational, and self-empowerment purposes ONLY. I am not responsible or liable for any advice, course of treatment, diagnosis or any other information, services or products that you obtain through Foster Health. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition

Confidentiality Notice

This form and any attached files herein contain information that is intended only for the use of the individual or entity to whom it is addressed and may contain information that is legally privileged, confidential or otherwise exempt from disclosure under applicable laws. If the reader of this message is not the recipient, any disclosure, dissemination, distribution, copying or other use or retention of this communication or its substance is prohibited.

Copyrights

All materials are copyrighted and remain the property of their respective owners. Materials made available to the private group forums, by email, or any other means, may not be distributed in any fashion, print nor electronic, without the expressed written permission of the respective owner. Thank you for your professional understanding

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