Form - Nutrition Services | Gold's Gym East Northport

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Start YOUR FREE Nutrition ConsultatioN

Start with a free, no-pressure consultation to discuss your goals, challenges, and what type of coaching will work best for you. Get personalized tips and see if we’re a good fit!

Order Number

Full Name *

Age

Email Address *

Phone Number *

Preferred Method of Contact *

Phone Call

Text

Are you currently a Gold's Gym member? *

Yes

What are you looking for support with? *

Nutrition Coaching

Workout Programming

Both Nutrition & Fitness

Not sure yet — I’d love to talk about it

What are your top 1–3 health or fitness goals right now?

How would you describe your current eating habits? (Select one) *

I eat mostly home-cooked meals with balanced portions

I eat a mix of home-cooked meals and convenience/processed foods

I often rely on takeout, fast food, or ready-made meals

My eating habits are inconsistent and vary day to day

I follow a specific diet plan (e.g., keto, vegan, intermittent fasting)

I’m unsure or don’t really think about my eating habits

What does your current diet look like?

Do you have any food allergies, intolerances, or dietary restrictions?

What kind of workouts do you currently do (if any)? *

Weight Training

Cardio

Group Classes

Yoga/ Mobility

Walking

I'm not working out right now

Other

How ready are you to start working toward your goals with guidance? *

I’m ready now!

I’m almost ready – just have a few questions

Just exploring – not ready to commit

Is there anything else you’d like me to know about you or your goals?

Gold's Gym

EAST NORTHPORT, NY

Gym Hours

Mon - Thurs: 5am - 10pm
Fri: 5am - 9pm
Sat: 7am - 6pm
Sun: 8am - 6pm

Contact

(631) 757-3377

Eastnorthport@goldsgym.net

1 Larkfield Road
East Northport, NY 11731

Start YOUR FREE Nutrition ConsultatioN

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