Nigel White Fitness

Questionnaire & Risk Assessment

Thank you for your interest in joining NGW Fitness. Please complete the below to the best of your ability and provide as much information as possible. The more detail we have, the better we can plan your training &/or nutrition. We want you to reach your personal goals and ensure you are doing so with training and nutrition that is complimentary.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Nutrition

We will do our best to include variety and foods that you enjoy in your plan, however please be aware that this will be dependant on your individual goals.
What is your broad approach to food? i.e. vegetarian / no restrictions / any intolerances or allergies etc.
Please list your protein preferences i.e. chicken, beef, fish, eggs, legumes, tofu, protein yoghurt, protein powder etc.
Please list your carbohydrate preferences i.e. potato, kumara, wraps, rice etc.
Please list your fat preferences i.e. olive oil, olives, nut butters, nuts, seeds, coconut milk, avocado, cheese etc.
Please list your fruit & vegetable preferences
Please list any treat preferences
Are there any foods you will NOT eat / dislike?
What is your current daily water intake?
What is your average hours of sleep per night & how is your quality of sleep?
How many servings of fruit and vegetables do you consume per day?
Do you currently smoke? If yes, how many per week?
Is your occupation sedentary?
How are your stress levels?
How is your ability to focus?
How is your memory recall?
How are your energy levels?
How is your libido?
How is your training performance?
How is your relationship with food?
Medical History
Have you been diagnosed with hypertension or high cholesterol?
Have you been diagnosed with either 1, 2 or pre-diabetes?
Have you been diagnosed with stress fractures, lower peak bone mass, osteoporosis or osteopenia?
Do you suffer from, or have you been diagnosed with heart disease, myocardial infarction, atrial fibrillation, bypass graft, or valve replacement?
Have you been diagnosed with kidney disease or reduced renal function?
Do you suffer from or have been diagnosed with an eating disorder?
Do you have a history of yoyo dieting?
Have you experienced unexplained weight gain & muscle loss?
Have you been diagnosed with anaemia, low iron, b12 or folate?
Have you had any gastrointestinal surgeries within the last 12 months?
If you answered yes to any of the above questions, please provide further detail below.
Are you currently taking any medications or supplements?
Self-Awareness
Are you happy within yourself?
Are you happy with how you look & feel?
Has your weight been stable in a place you are peacefully happy with for over 3-months?
Can you eat out with friends and order what you like without guilt, and remain weight stable?
Can you not track food for 5 days and know your approximate nutrition intake?
Can you miss a few training sessions without guilt, and remain weight stable?
Do you know when you are truly satiated and the difference between being tired, overtrained, emotional or dehydrated?
If you would like to provide further explanation on any of the above questions, please do so below.
Do you suffer from any health conditions (not covered above)?
Body Measurements & Composition

These will help us understand your body composition which will in turn assist in working out the best nutrition plan for you. While jumping on the scales is one way to measure change, body measurements and photos are truly valuable tools as they show shifts in composition. Your weight fluctuates daily due to hormones, sodium intake, how much water you’ve consumed etc. It can be easy to fixate on weight and become disheartened when the scales don’t shift, or you have a slight increase in body weight. That’s why measurements and photos are so important. Ideally get someone to take your measurements for you as it is more accurate. Don’t tense your muscles when taking measurements. Stand erect, but relaxed. Make sure the measuring tape is snug, not too tight (indenting the skin) or too loose. It should lie flat on the skin. Ideally, measurements should take place in underwear as clothing can cause inaccuracy. If possible, wear the same underwear every time you take measurements. I recommend using a mirror to ensure accurate tape placement. Record measurements to the nearest 1mm. Take each measurement 3 times. We will use the mean (by adding the values together and dividing by the number of measurements). Take photos at the same time of day. We suggest doing so first thing in the morning before you consume any food or beverages.

Body Measurements

Rows	Measurement 1	Measurement 2	Measurement 3
Left Arm (mm) Take measurement around the mid upper arm mid-way between shoulder & elbow - over your bicep). Keep arm hanging freely at the side and the palm facing the thigh.
Right Arm (mm) Take measurement around the mid upper arm (mid-way between shoulder & elbow - over your bicep). Keep arm hanging freely at the side and the palm facing the thigh.
Hips (mm) Take measurement around the largest part of your hips (widest part of your butt).
Left Thigh (mm) Take measurement from your mid-thigh.
Right Thigh (mm) Take measurement from your mid-thigh.
Waist (mm) Take measurement from the narrowest part of your torso (just above your belly button).

Body Composition & Age

Rows	Please complete below
Weight (kg)
Height (cm)
Body Fat Percentage (if known)
Visceral Fat (if known)
Age

Photos

Photos are a fantastic way to document change and are so good to look back on! Here are some recommendations for taking your pics: Please do so in underwear or tight fighting bike pants /shorts and a sports bra (for the ladies). Try to wear the same items of clothing when you take your check-in photos for consistency. Take your photos in good lighting. Avoid using a flash as it can cause shadows on your body. Don’t tense your muscles or suck anything in – just stand erect but relaxed! There are 3 photos to take – front, side & back. Please upload photos to your MyFitnessPal account.
Exercise & Activity
Please outline any exercise / physical activity you are currently engaging in. Include as much detail as possible in terms of what you are doing i.e., type of activity (weight training, yoga, boxing, HIIT etc.), length of time of each session, and frequency. If you wear a Fitbit / smartwatch, please indicate average number of steps per day.
Your goal - what is your why?
It’s important for us to understand your personal goals and reason for reaching out i.e., are you working towards a specific date or event, do you have a weight loss target, want to improve general health etc.
Barriers to achieving your goal
If you can think of any barriers that may impact you reaching your goal, please outline these i.e., events, work commitments, are you a stress-eater, go for convenience over nutrition, find it hard to say no etc. If we are aware of these, we can help you manage them and provide support.
Current Eating Habits

It is helpful for us to understand how, what and when you currently eat. Before we create your meal plan we'd like you to track your food for 1 week. This means tracking EVERYTHING – include sauces, oils, seasoning, hot and cold beverages – everything that goes in your mouth! We don’t expect you to weigh your food over this week, but please try to be as accurate as possible with your amounts / measurements. If you have (digital) scales and want to measure your food, that would be ideal. You can use MyFitnessPal or provide via email. Please don’t alter what you eat over this period. Just do as you normally would.
Disclaimer

At NGW Fitness we believe you should consult your physician or other health care professional before starting this or any other fitness plan/program to determine if it is right for your needs. This is particularly true if you (or your family) have a history of high blood pressure or heart disease, if you have experienced chest pain when exercising or in the past month when not engaged in any physical activity, have high cholesterol, or have a bone or joint problem that could be made worse by a change in physical activity. Do not start this fitness plan/program if your physician or health care provider advises against it. If you experience faintness, dizziness, pain or shortness of breath at any time while exercising you should stop immediately. At NGW Fitness we offer health, fitness and nutritional information and recommendations that is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional. Do not disregard, avoid or delay obtaining medical or health related advice from your health-care professional because of something you may have read on your plan/program. Your plan/program has been customised to you and your lifestyle. By accepting the terms you agree not to share or sell to anyone else. The use of any information provided by NGW Fitness is solely at your own risk.
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Questionnaire & Risk Assessment

Nutrition

Medical History

Self-Awareness

Body Measurements & Composition

Photos

Exercise & Activity

Your goal - what is your why?

Barriers to achieving your goal

Current Eating Habits

Disclaimer