CERTIFICATION MANUALThe Essentialsof Sport andExercise NutritionCLIENT ASSESSMENTFORMSFORMSBy John Berardi, PhD, CSCSRyan Andrews, MS, MA, RDBrian St. Pierre, MS, RD, CSCSKrista Scott-Dixon, PhDHelen Kollias, PhD, CSCSCamille DePutter
Copyright 2016 by Precision NutritionAll rights reserved. No part of this book may be reproduced or transmitted inany form or by any means, electronic or mechanical, including photocopying,recording, or by any information storage and retrieval system, without writtenpermission from the publisher.Published by Precision Nutrition, Inc.www.precisionnutrition.com
PRECISION NUTRITION FORMS IntroductionWhen to use the formsOutcome-baseddecision making.It’s at the heart of everything you do as a coach.1. You gather data.2. You analyze it.3. You decide what to do next, based on the evidence.As the saying goes:“If you’re not assessing, you’re guessing.”Indeed, the best coaches are always gathering, analyzing, and using data to make informed,outcome-based decisions.However, sometimes all that data can feel overwhelming.Each client comes to you with: different life experiences and a different personality; different wants and needs; different health conditions, movement capacities, and eating habits; different problem-solving abilities; and different attitudes about change and trying new things.As a coach, you need to triage — to understand what’s most important, right now, for eachunique client. Triaging helps you focus on “first things first” and set the right priorities.But how do you know: What information to gather? And when? What questions to ask? And how? The right way to discuss assessment and analysis with clients? How to walk them through the process step by step?Simple.We’ve already done the work for you.The assessment forms in this package will help you get to know your client better, and helpyou make better, evidence-based decisions about your coaching strategy.Using them, you’ll learn more about your client’s: Physiological indicatorsThis includes blood work, other lab tests, digestive function, and immunity
PRECISION NUTRITION FORMS IntroductionWhen to use the forms Body composition and measurementsThis includes height, weight, body girths, lean mass, and body fat Other health needsThis includes known allergies or food intolerances, medication use, other health problems,and the other health care providers they work with Function and physical capabilityThis includes mobility, daily-life tasks, and athletic performance Psychological state and mindsetThis includes readiness for change, resilience, and problem solving Environment and lifestyleThis includes social support, family, work hours and demands, and travel Goals and desired outcomesThis includes a specific goal weight or body composition change, decreased medicationusage, improved performance measures, and improved relationship with foodBuild your “coaching information database” by using these tools and techniques. And use itto generate strategic plans that your clients can stick with, and that you can feel good about.START WITH THE BASICS.We suggest you begin with The PN Initial Assessment and Triage Questionnaire, which covers: The client’s perspectiveThis includes expectations, goals, self-identified limiting factors, willingness to change, andwhat behaviors they’d like to focus on or change. Social factorsThis includes social support, stress, and relationships. Health indicators and conditionsThis includes injuries, medication use, and digestion. Lifestyle factorsThis includes how often they see the doctor, whether they smoke, how they spend theirtime, and how their kitchen is set up.Ask the client to fill it out beforehand if possible and bring it to your first session together.Filling out forms in advance gives them time to think and remember details.At that first session, discuss their responses with them. Look for more information, and try tounderstand their situation as much as you can. Going through the forms together gives youboth an opportunity to fill in any gaps and make sure you’re both on the same page.A good initial assessment helps you match your coaching plan to what the client can actuallyunderstand, manage, and do. This ensures that your clients go steadily from success tosuccess, rather than swinging wildly from resistance to anxiety to failure.The initial assessment also helps you to give clients an objective appraisal of what and howthey’re doing, helps you identify clients who are at risk for illness and / or injury, and helpsyou determine if you need to refer a client out, either because they fall outside your scopeof practice or because the relationship would be a mismatch (remember, referring out is animportant and valuable option).
PRECISION NUTRITION FORMS IntroductionWhen to use the formsAfter the first session, if you feel like the Initial Assessment and Triage Questionnaire raisessome additional questions you’d like to answer immediately, use some of the questionnairesand worksheets included here. These may help you: identify what’s most important to your client right now; learn what “progress” means for your client; identify specific ways to track progress with your client; collaborate on next actions together; ensure that your client is able to execute any tasks you give them; and / or focus on a particular area of interest, such as past / current health problems, sportnutrition, readiness for change, planning and time useKeep in mind: You don’t have to use all of these. We recommend you only try one at a time. Feel free to use them throughout the entire coaching process. Only use a form if you find it useful when making coaching decisions.COACH AND CLIENT FORMSMany of the forms have “coach” and “client” versions.CThe “coach version” is like a teacher’s guide to a classroom textbook. It explainswhat the form is used for, how to talk about the form with your clients, and whyyou might ask for certain types of information from your clients. Coach versionshave the symbol C.The “client version” is what your clients will see. Simple, to the point, only asking what’sneeded for each topic. You can give these to your client to fill out at home and bring toyour sessions.We suggest you review the “coach version” of each form before handing the “client” versionout. This will help you feel ready and able to explain each form. This will, in turn, help yourclients better understand what you’re hoping to accomplish and “buy in” to the process.
PRECISION NUTRITION FORMS IntroductionWhen to use the formsIndex of Precision Nutrition formsHere’s a list of all the worksheets, assessments and questionnaires contained in thispackage, including what each is used for.Index of formsWORKSHEET, ASSESSMENT,OR QUESTIONNAIREWHAT IT’S USED FORVERSIONSPN Initial Assessmentand Triage QuestionnaireHelps you match your coaching plan to what the client canactually understand, manage, and do. Also helps you togive clients an objective appraisal of what and how they’redoing, helps you identify clients who are at risk for illnessand / or injury, and helps you determine if you need to refera client out.Coach version14 Crazy Questions WorksheetFor helping clients think through the benefits of the statusquo and what they’ll have to give up to change.Client versionA-B-C WorksheetFor negotiating which specific exercises and / or foods clientscan / will do or eat. (At least right now.)Coach versionFor helping clients see choices as a continuum versusall or nothing.Coach versionAthletic Nutrition NeedsQuestionnaireFor understanding a client’s training goals, training volume,current recovery practices, and current nutrition practices.Coach versionBaseline Blood ChemistryAssessmentFor coaches who find blood work useful in the decisionmaking process.Coach versionBehavior Awareness WorksheetFor helping clients change unwanted habits and behaviors(such as stress eating).Client versionBody Measurements FormFor tracking body composition in clients who might benefitfrom regular measures.Coach versionEating Habits QuestionnaireFor learning more about a client’s eating patterns.Coach versionAll-or-None WorksheetClient version2Client versionClient versionClient versionClient version1 Coach versions contain scripts or background information that that you can use to either explain the form to yourclients, or to understand why we’ve asked certain questions. It’s like a “Teacher’s guide” for school teachers.2 Client versions of forms are for the clients to take home and fill out themselves.
PRECISION NUTRITION FORMSWORKSHEET, ASSESSMENT,OR QUESTIONNAIRE IntroductionWhen to use the formsWHAT IT’S USED FORVERSIONS3-Day Diet RecordFor recording exactly what a client is eating; most often forLevel 2 eaters.Client version80% Full Meal JournalFor helping clients learn how to eat until satisfied versusstuffed and tracking progress in this area.Client versionAthletic PerformanceIndicators & AthleteNutrition JournalFor correlating mood, energy, and motivation withdietary intake in hard-training athletes. Includes AthleticPerformance Indicators worksheet.Client versionEating Behaviors JournalFor capturing a client’s urges, cravings, and behaviors aroundmeals.Client versionEating Slowly Meal Journaland Meal Duration JournalFor tracking a client’s meal speed and whether they’reconsistently eating slowly and mindfully. Use Eating Slowlyfor subjective self-assessment or Meal Duration for objectiveself-assessment.Client versionEmotional Eating JournalFor capturing a client’s emotions and thoughts and how theymight lead to different food choices.Client versionHow Food Feels JournalFor capturing a client’s physical sensations (like allergies orintolerances) related to food.Client versionHand-Sized Portion GuideA simple guide to calorie control without calorie tracking.Client versionIdeas for MovementSuggestions for daily movement outside of scheduled“exercise”.Coach versionFor helping highlight the relationship between a client’senvironment and their food habits.Coach versionLimiting Factors, Advantages,and Behavior Goals LogFor identifying a client’s struggles, their advantages, and howto turn them into a plan for change.Coach versionMake It A Habit WorksheetFor moving from vague idea or outcome goal to specific habitand behavior goal.Coach versionMeal Consistency WorksheetFor tracking a client’s consistency with agreed-uponbehaviors and practices.Coach versionFOOD JOURNALSKitchen Set-up AssessmentClient versionClient versionClient version
PRECISION NUTRITION FORMS IntroductionWhen to use the formsWORKSHEET, ASSESSMENT,OR QUESTIONNAIREWHAT IT’S USED FORVERSIONSMedical History and PresentMedical Condition Questionnaire3Provides more detailed information about the client’soverall health.Coach versionPlanning & Time Use WorksheetFor clients who have problems with time management.Client versionPrecision Nutrition PlateA simple way to structure each meal the PrecisionNutrition way.Client versionPush-Pul-Habit-AnxietyWorksheetFor identifying what’s pushing clients away from old ways ofdoing things and pulling them towards new things.Coach versionReady, Willing, and AbleWorksheetFor helping establish how ready, willing, and able a clientis to make a given change. Also helps coaches “shrink thechange” to make it more manageable.Client versionSleep & Recovery IdeasFor helping coaches discuss sleep rituals and stressmanagement.Coach versionFor showing how social support influences a client’s eatingand movement decisions.Coach versionFor helping clients identify what they have control over and don’t.Coach versionFor showing patterns of sleep, stress, and recovery.Coach versionSocial Support FormSphere of Control WorksheetStress & Recovery QuestionnaireClient versionClient versionClient versionClient versionClient versionThe Hunger GameFor helping clients better tune into hunger and appetite cues.Client versionWant-Willing-Won’t WorksheetFor negotiating what clients want, and what they’re willing todo (or not do) for that goal right now.Coach versionClient version3 Remember that Medical Nutrition Therapy is off limits unless you’re a registered dietitian. We include this formso you can have access to the client’s medical history in case that needs to inform your advice.
PRECISION NUTRITION FORMS IntroductionWhen to use the formsUsing The Precision Nutrition FormsHere’s how to choose which form to use when.Session 1:Initial Assessment& Triage FormEnough data for now?YMove to exploring,understanding andworking withlimiting factorsNUse appropriateassessment forms;collect only the datayou needBodycomposition orweight changegoalPast or currenthealth problemsMedical History & PresentMedical ConditionBaseline Blood ChemistryAthletic / sportsnutritionAthletic Nutrition NeedsAthletic Nutrition JournalReadiness forchangeReady, Willing, AbleA-B-CWant-Willing-Won'tQuality of eatinghabitsHOW TO GET THE MOST OUT OF OUR ASSESSMENT FORMSBody MeasurementsStep 1: Eating HabitsStep 2: How Food Feels;Behavior Awareness;Meal ConsistencyStep 3: 3-day dietary recordPlanning& time usePlanning & Time UseSphere of ControlWant-Willing-Won’tSocial supportand householdSocial SupportKitchen Set-upStress andrecoveryStress & RecoverySphere of ControlPlanning & Time UseKeep it simple.Use as few forms as possible. Gather only the information you need right now.Have a conversation first.Use the forms to open up a discussion with your client. Ask for moreexplanation about their answers, or “Tell me about ”Address one thing at a time.Collaborate with your client on setting priorities and deciding what is mostimportant to work on.Make outcome-based decisions.Decide what to do next based on the evidence and information you have.Client progressionLimiting Factors,Advantages, and BehaviorGoalsMake It A HabitWant-Willing-Won't
CPN Initial Assessment & Triage QuestionnaireNAMEDATECoaching tips You can use this form both for an initial baseline assessment and to track progress periodically. Client responses to questions can suggest what areas to work on and track. You can also use questions such as the 1-10 numeric scores to track objective progress in particular areas (e.g., “Rightnow, how would you rank your overall eating / nutrition habits?”).Tell me more about yourself.By learning more about your lifestyle and your habits, I can take better care of you and make sure coaching is a good fit for yourgoals and individual needs.DATE OF BIRTHGENDERStaying in touchPlease print clearly.EMAILMOBILE PHONEHow do you prefer me to contact you? Phone Skype or other video chat TextEmailEmergency contact name:Emergency contact phone number:Other (please specify):Coaching tips Ensure that all contact information is complete and correct. Confirm with client how they would like to be contacted, and how often. 2016 Precision Nutrition precisionnutrition.comHOME PHONE
CPN Initial Assessment & Triage Questionnaire (cont’d)What do you want?In general, what are your goals? Check all that apply. Lose weight / fatImprove physical fitnessGain weight Get control of eating habitsLook better Maintain weight Feel better Physique competition / modeling Add muscle Have more energy and vitality Improve athletic performanceGet strongerCoaching tips Don’t take any of these at face value. Clients may change their goals, say what they think you want to hear, think theywant one goal but really want another, and / or simply not have a clear idea of what these categories mean. Use these categories as discussion starters. Ask for clarification and help clients explore how they will know when theyreach their goals. “When you say ‘improve physical fitness’, what specifically do you mean by that?” “When you say ‘get stronger’, is that in a particular exercise? Or just an overall feeling? How will you know when youare ‘stronger’?” “You’ve listed ‘look better’. Is there a particular event you want to look better for, or is this more of a general thing?What does ‘look better’ mean to you exactly?” Revisit this question above periodically to ensure that these goals are still meaningful and important to your client. “On [date], you said that goal X was important to you. Does that still feel true?”Please list all of your concerns about your health, eating habits, fitness, and / or body. 2016 Precision Nutrition precisionnutrition.com
PN Initial Assessment & Triage Questionnaire (cont’d)CCoaching tips This section starts off with a “brain dump” or “airing of grievances” — all the things that your client is potentially worriedabout, frustrated with, etc. The larger purpose here in the first question is for your client to simply brainstorm, to get their wishes out of theirhead and on to paper, and to expose their concerns to the light of day. The simple act of writing down their concerns will sometimes start changing those concerns without you doinganything at all! IMPORTANT: You don’t have to address all of the concerns in the first question. In fact, you may address almost none of these concerns directly, and many concerns may self-resolve over time asyou put foundational habits in place. Do ONE thing at a time, following what your client identifies as top priorities. For many people, this may be the first time they’ve shared these concerns. Be empathetic. It may feel overwhelming tothem too. Reassure them, if needed, that you are here to help them find a path through the weeds, and that your action plan willinvolve a clear strategy to work through these concerns step by step. If you ever want to dig into exactly what trade-offs your client is willing to make, you can explore with them using theWant-Willing-Won’t Worksheet.Out of all of the above concerns, which ones feel most important / urgent?1.2.3.Why? 2016 Precision Nutrition precisionnutrition.com
PN Initial Assessment & Triage Questionnaire (cont’d)CCoaching tips These two questions above ask your client to start organizing their thoughts, and begin to define what is urgent /important / a priority for them. Asking why something feels most important / urgent helps to surface your client’s values, perspective, motivations, andexpectations. Consider using the 5 Whys exercise if you’d like to learn more about your client’s deeper motivations (outlined inChapter 10). Asking “why” can also help bring up any potential tensions or areas of resistance (e.g., “My doctor says I shouldchange X, but I’m not sure if I agree.”). When these tensions appear, explore them with motivational interviewing. If something seems urgent, ask more about expected timelines. How quickly does the client need / want things to change? Is there a deadline (e.g., an upcoming wedding, competition, or other specific event)? Ranking priorities can help later on when a client may want to switch goals or do several things at once. “Back on [date], you said that goal X was the most important priority for you because reason Y. Is that still true? If so,then let’s stay focused on that. If not, let’s revisit what is a priority for you now.”What do you expect?What do you expect from me as your coach?What are you prepared to do to work towards your goals?Coaching tips Having clear expectations for both coach and client is essential. Identify and discuss any potential areas of ambiguity or misfit (e.g., client wants to be contacted daily, but you normallycontact clients weekly). The second question not only clarifies what clients are bringing to the table, but emphasizes that the coachingrelationship is largely about the client’s responsibility. You can use this as a jumping-off point to talk about your role as aguide and facilitator, but not “the boss” or responsible for the client’s participation. The second question here can open up a discussion about “ready, willing, and able”. Consider using the Ready, Willing, and Able Worksheet here if needed. 2016 Precision Nutrition precisionnutrition.com
CPN Initial Assessment & Triage Questionnaire (cont’d)What do you want to change?Have you tried anything in the past to change your habits, your health, your eating, and / or your body?If so, what?YWhich of those things worked well for you? (Even if you might not be doing it right now.)Which of those things didn’t work well for you?Coaching tips These questions help you learn more about a client’s general history of health, eating and exercise, as well as howknowledgeable and / or competent they may be in these areas. These questions also offer some coaching opportunities. Testing the evidence: “How did those things work for you?” This highlights that most fad diets / workouts are ultimately unsustainable. Admitting this can help a client “break”from previous unhealthy or unworkable options. If previous things worked well, these can be “bright spots” and clues about what might help your client (e.g., “I wasmost consistent when ”) Learning moments: “What did you learn from doing this?” If the client is are focused on “what didn’t work”, this can reframe their experiences. Affirming the client’s drive, courage, and grit: “What strikes me here is how many times you tried to change. Eventhough you didn’t make as much progress as you wanted, you were still trying. That tells me you really want to moveforward with this, and that you’re courageous and persistent.” Here, you can reframe “failures” and highlight change potential by pointing out that despite setbacks, the client kepttrying to find solutions. 2016 Precision Nutrition precisionnutrition.comN
CPN Initial Assessment & Triage Questionnaire (cont’d)How, specifically, would you like your habits, your health, your eating, and / or your body to be different?Coaching tips This question helps you learn more about and clarify what the client wants, and more precisely how they imaginechange. This question also suggests possible progress indicators to use. For example, if the client says, “I’d like to have more energy”, you can use energy levels as one measure of progress.Have you already made changes to your habits, your health, your eating, and / or your body recently?If so, what?YNIf you were to consider making further changes to your habits, your health, your eating, and / or your body, what might those be?Coaching tips These questions help you and the client identify what actions may be priorities for the client; and / or what the clientfeels ready, willing, and able to do right now. Keeping the question open-ended and about the potential (“if you were to consider”) encourages the client to thinkabout change, and to identify what they want to happen, without feeling too much resistance. These questions can help the client start to commit to a possible course of action, if they are ready, willing, and able todo so. Many clients have already started to make changes by the time they get coaching. Call this early change out, validate it,and look for “bright spots” that you can build on. If the client suggests several potential changes, talk with them further about which changes might feel most important,urgent, and / or possible, and why. 2016 Precision Nutrition precisionnutrition.com
CPN Initial Assessment & Triage Questionnaire (cont’d)Until now, what has blocked you or held you back from changing these things?Coaching tips The client’s answer here will help you understand what forces are acting against change for the client. What are their limiting factors? What forces are “pushing back” against change? This question can also help you find out why the client is considering change now. Why this, why now? Why not last month, or next month? What happened to bring your client here now? Given the forces acting against change, what propelled the client to act? Often there is some significant, precipitating event (e.g., an injury, a medical diagnosis, a family member dying orgetting sick). Knowing this can tell you more about the client’s motivation and drive.Right now, how would you rank your overall eating / nutrition habits?HORRIBLE12345678910AWESOME!!!Why?Coaching tips Clients often rate their eating / nutrition as better than it actually is. Thus, if the client scores 8 or lower, consider usingthe Eating Habits Questionnaire. If the client describes behavior that sounds like possible disordered eating / emotional eating, consider using EmotionalEating Journal as part of a coaching action plan.Are you regularly active in sports and / or exercise? 2016 Precision Nutrition precisionnutrition.comYN
CPN Initial Assessment & Triage Questionnaire (cont’d)If so, approximately how many hours per week? Fewer than 5 hours5-9 10-14 20 or more15-19Coaching tipIf the client indicates 5 or more hours per week, consider using the Athletic Nutrition Needs Questionnaire.What types of sports and / or exercise do you typically do?Approximately how many hours a week do you do other types of physical activity? (e.g., housework, walking to work or school,home repairs, moving around at work, gardening) Fewer than 5 hours5-9 10-14 20 or more15-19What other types of movement and / or activities do you do?Coaching tips Look for a balance of activities, as well as between activity and rest, intensity and rejuvenation. Is your client gettingenough variety and recovery? For clients who want to lose weight or improve nutrient partitioning, look for opportunities to add daily-life activity,ideally by building on what they already do, for example:“You mention you walk your daughter to school every day. I’m wondering whether you could take a slightly longerroute home to give yourself a few extra minutes of walking?” Explore your client’s attitudes towards and expectations of sports, exercise, movement and activity, for example: Are they having fun? Do they know how to play? What are their expectations for their performance? Does activity seem like a chore? Do they expect exercise will help them lose weight?Is that expectation accurate? How hard are they driving themselves? How consistent are they? 2016 Precision Nutrition precisionnutrition.com
CPN Initial Assessment & Triage Questionnaire (cont’d)What’s around you?Who lives with you? Check all that apply. Spouse or partner(s)Roommate(s) Child(ren) Other familyPet(s)YDo you have children? If yes, how many and what are their ages?NCoaching tips Knowing about your client’s household, relationship, and / or family situation will help you understand things like: what roles they might play in relation to other people (e.g., caregiver, financial provider); what other time and energy demands they might have (e.g., child care, elder care, stay-at-home parent vs. workingoutside the home); who might be setting the agenda in the household (e.g., “I have to please my kids” or “I’m in charge of menuplanning”); and / or how much structure the household might have (e.g., student household with roommates vs. mature family with wellordered routines). Knowing the specifics of your client’s family situation will also allow you to relate to them as individuals (e.g., Client X isnewly married, Client Y is starting a family, Client Z is a dog lover)Who does most of the grocery shopping in your household? Check all that apply. MeSpouse or partner(s) Roommate(s) Other family (e.g. parent, grandparent,sibling, etc.) Other familyChild(ren)Who does most of the cooking in your household? Check all that apply. MeSpouse or partner(s) Roommate(s)Child(ren)Who decides on most of the menus / meal types in your household? Check all that apply. MeSpouse or partner(s) 2016 Precision Nutrition precisionnutrition.com Roommate(s)Child(ren) Other family
CPN Initial Assessment & Triage Questionnaire (cont’d)Coaching tips These questions can tell you more about: your client’s skill, knowledge and responsibility around shopping and food preparation; and your client’s ability to make choices (real or perceived). If any other people are doing the bulk of shopping, cooking, and / or food decisions, consider how to include them inyour client’s coaching program so that they are on board with any changes. If the client doesn’t seem to have strong food preparation skills, or if the kitchen / home environment may be a limitingfactor, consider using the Kitchen Set-up Assessment.Right now, how much do the people and things around you support health, fitness, and / or behavior change?NOT AT ALL12345678910COMPLETELYCoaching tipIf the client scores 7 or lower, consider using the Social Support Form and Kitchen Set-up Assessment.What’s your health like?Have you been diagnosed (currently or in the past) with any significant medical condition(s) and / or injuries?YNRight now, do you have any specific health concerns, such as illnesses, pain, and / or injuries?YNRight now, are you taking any medications, either over-the-counter or prescription?YNCoaching tipIf the client answer “yes” to any of these, consider using the Medical History and Present Medical Condition Questionnaire. 2016 Precision Nutrition precisionnutrition.com
CPN Initial Assessment & Triage Questionnaire (cont’d)On a scale of 1-10, how would you rank your health right now?WORST12345678910AWESOME!!!Why?Coaching tipIf the client scores 7 or less, consider using the Medical History and Present Medical Condition Questionnaire.How are you spending your time?In an average week, how many hours do you spend.In paid employment?At school or doing school work?Traveling and / or commuting?Taking care of others?(e.g., children, person witha disability, older person)Doing other unpaid work?(e.g., housework, errands)Volunteering?Adding up all these things, how many total hours per week do you spend doing all these activities?Coaching tipIs this how many hours the client prefers to be spending on these activities? If they feels rushed / busy / time pressured,consider using the Planning & Time Use Worksheet.On a scale of 1-10, how do you feel about your schedule, time use,
CERTIFICATION MANUAL The Essentials of Sport and Exercise Nutrition Precision Nutrition By John Berardi, PhD, CSCS Ryan Andrews, MS, MA, RD Brian St. Pierre, MS, RD, CSCS Krista Scott-Dixon, PhD Helen Kollias, PhD, CSCS Camille DePutter FORMS CERTIFICATION MANUAL The Essentials of Sport and Exercise Nutrition CLIENT ASSESSMENT FORMS