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Metabolic Assessment Form

Let’s figure out exactly what your body needs — so you can finally see results that last.

I created this form to give you a detailed breakdown of where your metabolism is currently at — and what’s keeping you stuck.

Once you fill this out, I’ll review it and get back to you with your personalized recommendations.

The more detail you give me, the better I can help you. So don’t hold back — be honest, be specific, and take your time.

Full Name *

Best way to contact you? *

(please provide your phone number if you prefer me to contact you via text message )

Age *

What's your email address? *

Where are you located? *

What's your weight? (pounds) *

What's your height (feet) *

How old are you? *

What is your #1 goal right now? *

(Examples: weight loss, gain muscle, tone up, feel more energetic, fix my relationship with food — be specific)

If your goal is fat loss, how much weight would you like to lose — ideally? *

How long have you been struggling with this goal? *

(explain in detail)

How your typical day of eating look like? If you know how much you are eating on average please write it down *

(types of foods, portions etc .. be as detailed as possible please)

Have you ever done extreme dieting in the past? (Very low calorie, keto, fasting, cardio-only, etc.) If yes, give a quick summary. *

Why did it fail? (not sustainable , lacked commitment, not enough time, not enough information, too hard, etc.) *

How would you rate your digestion? (1 = constipated or bloated all the time, 5 = happy poops, no issues) *

What's your Instagram username? If you don't have one please leave a link to your FB profile! *

Make sure to follow me on IG @martina_fit_yyc as I will be reaching out in the DMs. Make sure to check your messages!

What do you usually eat when you go out for food? *

List restaurants and menu items

Roughly how many steps do you take per day? (If you track) *

How many hours of sleep do you usually get per night? *

How would you rate your daily stress levels (1 = very low, 10 = extremely high)? *

Do you ever feel extremely tired after meals, or experience major sugar cravings during the day? (Optional) *

Do you take any supplements or medications? (If yes, list them.) *

Do you have any known hormonal or metabolic conditions? *

(Examples: PCOS, hypothyroidism, insulin resistance, irregular cycles, etc.)

What do you do for work? *

Our daily movement plays a huge role in your results. Be specific — what kind of job do you do, and how much do you move throughout the day? (Example: “I work as a nurse, on my feet all day” or “I work from home at a desk 8 hours a day, minimal movement”)

What does your current exercise routine look like? *

(Example: “I lift 3x/week and walk 20 mins a day” or “No routine, but I try to walk daily”)

Have you ever worked with a coach or followed a plan before? What worked? What didn’t? *

I want to hear your WHY. Why is it important to you to hit this goal? *

(Examples: I want to feel confident in my clothes, have more energy for my kids, stop obsessing about food, improve my health, etc.)

What do you feel is holding you back the most right now? *

(Examples: I feel lost with nutrition, I lack structure, I’m inconsistent, I don’t have support, I binge eat, etc.)