Questionnaire Form

Name *

First

Last

Email *

Checkboxes

Male
Female

Age *

Height *

Weight *

approx If workout

What are your fitness goals? If doing a competition prep please include date, name and location of the show *

What time do you wake? What time do you go to bed? When do you weight train? * *

What type of cardio do you mostly do? How long and how often per week? * *

Please provide a sample of your typical daily food intake. Include the time of your first meal and a breakdown of everything you eat throughout the day (meals, snacks, beverages, etc.) along with approx times. *

Where do you train? If at home, what equipment do you have? (You can skip this if you didn’t purchase workout plans)

List any food allergies and current supplements, including vitamins *

List any foods that you avoid such as meat, dairy, gluten etc. * *

List daily beverage intake, including alcohol, and how much of all beverages is consumed. *

How did you hear about me? * *