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home
group training
programming
open gym memberships
testimonials
recent posts
media
articles and blogs
Instructional Videos
Exercise Demonstrations
Eat-Nap-Lift (Podcast)
the gym
contact
nutritional support
Please Complete the form below, which will describe your dietary goals
Name
*
First Name
Last Name
Email Address
*
I would like to receive exclusive content and offers, as well as 'Drew's 3 Tips For Bouncing Back Fast After Binge Eating.'
Yes, please!
No thank you.
How did you hear about Drew Murphy Strength?
Found the website
From a friend
Facebook
Instagram
Other
Which of the following types of eating have you followed in THE PAST?
Select all that apply.
Low carb/Ketogenic
Paleo
Clean Eating
Intermittent Fasting
IIFYM
Calorie Counting
Calorie Restriction
Vegan
Vegetarian
I Have Never Followed A Diet
Please elaborate on any of the selections you made above.
Which of the following types of eating are you CURRENTLY FOLLOWING?
*
Please select all that apply.
Low carb/Ketogenic
Paleo
Clean Eating
Intermittent Fasting
IIFYM
Calorie Counting
Calorie Restriction
Vegan
Vegetarian
I Do Not Currently Follow A Diet
Other
Please elaborate on any of the selections you made above.
What are your dietary goals?
*
Please select all that apply.
Accountability
Learn Better Eating Habits
Eat Healthier
Preparing For An Event
Decrease Body Fat
Gain Muscle
Eat For Better Energy
Other
Please elaborate on any of the selections you made above. If you have a primary training goal, please explain here.
On a scale of 1-10, how motivated are you to achieve your dietary goals? (1 = unmotivated, 10 = very motivated)
*
1
2
3
4
5
6
7
8
9
10
How many meals per day do you eat (on average)?
*
How much water do you drink per day (on average)?
*
I have no idea.
Hardly any.
A below average amount.
An average amount.
An above average amount.
I drink plenty of water.
How often do you use seasoning and condiments?
*
Never
Sparingly
A lot
Please list seasonings and condiments you regularly use.
Please list any food allergies/sensitivities you are aware you have.
Are there any specific foods or types of foods you are unwilling to eat?
Health History
Please select all that apply.
High Blood Pressure
Diabetes
Liver Disease
Pregnant/Nursing
Shortness of Breath
Dizziness
Seizures
Heart Problems
Fractures
Joint Pain
Arthritis
Headaches
Smoker
Recent Surgery
Major Illness
Cancer
Asthma
Allergies
Neurological
Respiratory
Hernia
Scoliosis
Poor Balance/Coordination
Back Pain
Knee Pain
Shoulder Pain
Please explain all selections you made above.
Please describe your current eating habits.
You can tell me how you eat in general, or be as detailed as to break down what a typical day of eating looks like for you.
Thank you! We will review this and be in touch soon!