Welcome to IronImmersion with Stacy Sims

When filling out this form, please provide enough detail so that I can focus on developing your plan instead of finding out what it is that you already do. This makes things run smoothly and efficiently over the 6 weeks. Note that the last questions - Meal and Snack Timing - MUST be filled out.

If at any time you lose the form, it most likely submitted it. Pick up where you left off and submit the form again. It will come to us in two pieces, which is perfectly fine. 

Average time to fill out this form: 45-60 minutes.

Thank you! 

Name *
Name
Today's Date *
Today's Date
Phone Number Where Stacy Can Reach You
Phone Number Where Stacy Can Reach You
Date of Birth
Date of Birth
i.e. weight you feel is your race weight or weight you feel best
A. Your nutritional goals: Please be specific
e.g. energy, sleep quality, longevity, pregnancy, etc
e.g. blood pressure, joints, diabetes, etc
your sport, performance goal, dates of upcoming competitions
B. Additional topics or questions you would like covered not listed above
C: Training Load
State how many hours PER WEEK of exercise you are currently doing at the following intensities. Workouts typically contain components of ALL these. It is up to you, using your best judgment, to break it down into these categories.
D. The following questions concern exercise nutrition
what and how much and brand of product
what, how much, and brand of product
E. The following questions concern fluid and salt intake not associated with exercise
not including for exercise discussed above
or other low-cal sweetened drink:
F: Salt Consumption
NOT including electrolytes during and right after exercise already discussed
G. Foods preferences
Use the below categories to help you answer the following questions
Unsaturated Fats
Avocado • Nuts: Walnuts, almonds, cashews, pecans, peanuts, etc • Nut butters: Peanut butter, almond butter, cashew butter, soybutter • Seeds: Flax, pumpkin, sunflower • Plant oil: Olive, Canola, Corn • Fish: Salmon, (the other low-mercury fish listed in the protein column are relatively low in fat content)
Moderate Protein
Eggs • Dairy: Milk, cottage cheese, yogurt, ricotta cheese. SPECIFY NONFAT, LOW FAT, OR REGULAR • Soy milk • Tofu products • Chicken- white meat only • Turkey • Beef • Legumes: Beans, lentils • Fish high in omega-3 fat that are low in mercury: Salmon, sardines • Other seafood low in mercury: perch, whiting, tilapia, hake, shellfish
Whole Grain Starch
• Whole grain, bread, bagel, English muffin • High-fiber cold cereal,(i.e. Nature Path, Kashi Go Lean) • High-fiber hot cereal: Oatmeal, Oat bran, Wheetena, etc • Brown, Wild rice • Whole grain pasta • Yams, potato Whole grain crackers
Fruit, Vegetable
grapes, berries • Citrus, Grpfrt • Apricot, cherry • Apple, • Small bananas • Mangos, papaya • Bag spinach • Mixed greens or Spring mix • Kale, chard • Broccoli • Parsley, mint • Red Leaf • Red cabbage • Carrot, radish • Tomato • Cauliflower • Onion, garlic • Zucchini
H. Describe your meals and snacks - Please be as complete as possible!
list the ingredients in your meals, not the amounts; also include BRAND NAMES if possible
Breakfast - What You Commonly Eat (please be as complete as possible, write as many as needed)
EXAMPLE: Skim milk with bran flakes or oatmeal and a glass or OJ ANOTHER EXAMPLE: Eggs whites with salsa and an English muffin with butter
LUNCHES - WHAT you commonly eat (please be as complete as possible, write as many as needed):
EXAMPLE: Deli sandwich on whole grain bread with turkey or roast beef and lettuce/tomato ANOTHER EXAMPLE: Salad with dressing, rice with chicken or beef
DINNERS - What you commonly eat (please be as complete as possible, write as many as needed):
SNACKS - what you commonly eat (please be as complete as possible, write as many as needed):
please describe in detail what you do as soon as you get off your bike, before your shower/i.e. within the first 30-45 min after a training session
What foods, how often, and in what amounts?
I. Meal and snack timing
For each day of the week describe your typical day including the time sequence of snacks, meals and exercise. Include Time range of exercise, and when you go to work or school, and time that you wake up and go to sleep.
Example: Wake up and 7am, snack of X at 7am, exercise 7:30-9am, snack Y at 9am, work 10-6pm, lunch at 11am, snack at Z at 3pm, exercise 6-7pm, dinner at 7pm, snack at 10pm, sleep at 11pm.
Example: Wake up and 7am, snack of X at 7am, exercise 7:30-9am, snack Y at 9am, work 10-6pm, lunch at 11am, snack at Z at 3pm, exercise 6-7pm, dinner at 7pm, snack at 10pm, sleep at 11pm.
Example: Wake up and 7am, snack of X at 7am, exercise 7:30-9am, snack Y at 9am, work 10-6pm, lunch at 11am, snack at Z at 3pm, exercise 6-7pm, dinner at 7pm, snack at 10pm, sleep at 11pm.
Example: Wake up and 7am, snack of X at 7am, exercise 7:30-9am, snack Y at 9am, work 10-6pm, lunch at 11am, snack at Z at 3pm, exercise 6-7pm, dinner at 7pm, snack at 10pm, sleep at 11pm.
Example: Wake up and 7am, snack of X at 7am, exercise 7:30-9am, snack Y at 9am, work 10-6pm, lunch at 11am, snack at Z at 3pm, exercise 6-7pm, dinner at 7pm, snack at 10pm, sleep at 11pm.
J. LADIES ONLY
OH MY GOST!!!! You made it!!! Once you hit submit, Stacy will start communication within 3 business days.

Thank you!