First Name
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Last Name
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Email
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Phone
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Instagram Handle
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Facebook Name
Date of birth
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Weight?
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Height?
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Gender
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How did you hear about BA?
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Instagram
Facebook
Google Search
Competition
Active BA Member
Other
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History with food insecurity?
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Yes
No
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Have you ever tracked your macros before?
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Yes
No
Do you track your food intakes with MyFitnessPal or similar app?
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No
Yes
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Do you have a food scale?
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No
Yes
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Describe your typical diet (please list macros if tracking)
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About how much water do you drink daily?
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Please list all current medications and supplements.
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How much cardio do you currently perform weekly? Please include type and total time.
What are your short and long term health and fitness goals?
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Have you had recent bloodwork drawn? If yes, on what date?
Which dietitian would you prefer to have your consult with?
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Shane Park
Dylan Bair
Choose a dietitian for me based on my personal needs.
Please confirm you are interested in a one-time consult. Rates begin at $200 and plan updates are purchased separately.
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Yes
No
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