PLEASE FILL OUT OUR NEW CLIENT QUESTIONNAIRE BELOW. AFTER COMPLETEING, CLICK SUBMIT
NEW CLIENT QUESTIONNAIRE
FULL NAME:
*
First Name
Last Name
EMAIL:
*
example@example.com
CELL PHONE:
*
-
Area Code
Phone Number
ADDRESS: (BEST FOR SHIPPING)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SEX:
*
MALE
FEMALE
AGE:
*
CURRENT BODY WEIGHT:
*
DESIRED BODY WEIGHT:
*
CURRENT BODY FAT % (USE PICS ABOVE):
*
DESIRED BODY FAT % (USE PICS ABOVE):
*
CURRENT ACTIVITY LEVEL:
*
SEDENTARY (I'm currently not active)
LIGHT (1 - 2 days per week)
MODERATE (2 - 3 days per week)
VERY ACTIVE (3 - 5 days per week)
I"M ACTIVE EVERY DAY
WORKOUT EXPERIENCE:
*
(0 - 1 YEARS)
(1 - 3 YEARS)
(3+ YEARS)
WHAT BEST DESCRIBES YOUR GOALS?:
*
I WANT TO LOSE 5 - 25 LBS & LEAN UP
I AM SKINNY & WANT TO GAIN SIZE & STRENGTH
I AM OVERWEIGHT & WANT TO LOSE 50 - 100+ LBS
I AM ALREADY LEAN & WANT TO GET LEANER
WHAT DESCRIBES YOUR NATURAL EATING RHYTHM:
*
2 MEALS + 2 SNACKS PER DAY
3 SQUARE MEALS PER DAY
MOSTLY SMALL SNACKS + 1 MEAL PER DAY
PLEASE TAKE US THROUGH A TYPICAL EATING DAY FOR YOU (OPTIONAL):
PLEASE BE HONEST! THERE IS NO JUDGEMENT! THIS IS JUST SO WE CAN HELP COACH YOU BETTER.
PLEASE LIST ANY KNOW FOOD ALLERGIES OR SENSITIVITIES?
PLEASE LIST ANY KNOW INJURIES, SURGERIES OR CHRONIC PAINS?
PLEASE LIST ANY ADDITIONAL INFORMATION THAT YOU WOULD LIKE US TO KNOW
""EVERY NEXT LEVEL OF YOUR LIFE WILL DEMAND A BETTER VERSION OF YOU"
SUBMIT MY QUESTIONNAIRE
Should be Empty: