Rob Goodwin (Founder)
In the Gym
Online Training Inquiry
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Your goal weight
Have you been advised by a doctor to lose weight or improve a specific health marker?
What is your age?
Less than 13
Prefer not to say
Reason for consultation and/or goals
How did you hear about the ketogenic diet?
Are you currently on or trying to be on a ketogenic diet?
I'm trying but need help
Are you opposed to investing in a monitor to regularly check ketone levels?
Not at all, sounds cool.
Yes, I don't want to get that complicated
I have no idea what you're talking about
What's a ketone??
Which "diets" have you tried?
High carb / low fat
Which phrase best describes you
I have to have breatfast!
“I rarely eat breakfast, I'm just not hungry in the morning”
“I'd love to have breakfast, but there's never enough time... so I just grab something quick and eat it on the way to work/school”
If Other please specify:
How many times do you usually eat per day?
Would you say you're addicted to sugar or carbs?
My biggest downfall is:
Soda / sweet tea
Salty processed snacks
I'm a meat eater
Raely eat it
I'm a vegan
Beverages I regularly consume
Other fruit juices
How many days per week do you have an alcoholic drink?
I don't drink
List any food alergies or sensativities you have
How many days per week does your family gather around a family dinner table and eat freshly prepared (not take out) food?
How many times per week do you eat "fast food"?
List your top 5 "healthy" foods
List your top 5 "cheat" foods
"You need to know that I am absolutely addicted to:"
Which oils do you use/consume regularly?
Which of the following carbs do you eat regularly?
Muffins / Bagels
Cakes, cookies, pancakes, waffles, pastries, etc
Do you like vegetables?
Do you eat fruit?
Yes, a lot!
I will absolutely NOT eat/drink the following no matter what you tell me!!!
Protein / healthy fat shake
I'm good with all of these!!
"I am still having a hard time wrapping my head around the notion that fats are healthy and will help me lose weight?
Yes, this is opposite of everything I've heard"
"No, I get it now, I've been enlightened"
"Though still odd to me, I'm ready to trust this and go all in!"
What did you eat yesterday?
Which prescription and over the counter medications do you take currently?
Do you take any nutritional supplements or vitamins?
Please list any disease, illness, or ailments in your immediate family
Do you have any of the following?
Type 2 diabetes
Type 1 diabetes
GI issues, stomach distress
Difficulty losing weight
High blood pressure
Daily energy level
Daily stress level
How many days a week do you strength train? (Lift weights)
How many days a week do you do aerobic exercise? (walk, run, bike, swim, etc)
How is your sleep?
Do you have a good support network of people around you?
No, this will be difficult
"I'm willing to do this regardless of what others say"
List ANYTHING else that you feel is important for me to know wbaout your health, lifestyle, habits, or anything that will assist me in making this work for you
On a scale 1-10, How determined are you?
Always consult your qualified personal health care provider before making any dietary or exercise changes. Rob Goodwin and any contributors of this writing disclaims any liability or warranties of any kind arising directly or indirectly from use of this writing. If any medical problems develop, always consult your qualified personal health care provider. Only your physician can provide you medical advice.
Although millions of people have been able to transition to a very low carbohydrate diet without documented harm, there are some for whom a low-carb/ketogenic diet must be approached with some caution. If you are taking medication to control your blood sugar or blood pressure, you may need to quickly reduce the dosage and may need to discontinue these meds altogether if you significantly restrict your carbohydrate intake. This is best done under the supervision of a doctor.
Although we stress the consumption of only moderate levels of protein and is not a “high protein diet”, for anyone who has serious kidney disease, any increase in dietary protein can be a problem. If you have kidney disease you should consult your doctor before making any changes to your diet.
If you have gallbladder attacks or gallstones you should exercise extreme caution where increasing dietary fat is concerned and you may first need to resolve this issue with your trusted, licensed health care provider before embarking on any major dietary change.
Anyone who has any other serious illness such as unstable cardiovascular disease, cancer or liver disease needs to exercise caution if making dietary changes. You should consult your physician for guidance.
Finally, if you are pregnant or lactating you should not overly restrict protein (or fat) intake. Also, young children and teens have much more demanding nutrient needs and should not have their protein or fat intake overly restricted. There is still no dietary carbohydrate (sugar or starch) requirement but know that radical changes to your existing diet if you are pregnant–other than eliminating junk foods–may not be advisable and should be approached only under the guidance of a qualified and knowledgeable health care professional.
I, the undersigned, also understand that any nutrition and nutritional supplementation advice is for information purposes only and is not intended for my individual prescription. And, if I decide to follow any such information I do so at my own risk.
By initialing and entering your name in the electronic signature box below, you agree to the above waiver of liability and hereby agree that your electronic signature is legally binding.
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Rob Goodwin (Founder)
In the Gym
Online Training Inquiry