Name
*
Email
*
Gender
*
Male
Female
Age:
Current height (feet/inches)
*
Current weight (pounds)
*
Do you currently follow an Animal Based way of eating?
*
Yes
No
Sometimes
If no, describe your typical diet:
Do you know how to measure and track your macros?
*
Yes
No
A little but need some help
Do you currently exercise on a regular basis?
*
Yes
No
Sometimes
If yes, describe the type of exercise, time per session, and number of sessions per week:
What type of exercise equipment do you have access to or are willing to purchase?
*
What is your primary goal?
*
Build muscle
Lose body fat
Increase health and well being
Other
If other, please describe:
How motivated are you to stick with an exercise and diet plan to achieve your goals?
Not at all
1
2
3
4
I'll do whatever it takes!
5
1 is Not at all, 5 is I'll do whatever it takes!
How much time are you willing to dedicate to achieving your goals?
*
Less than 2 months
2-3 months
3-6 months
6 months or more
How did you hear about me?
Any questions or concerns you would me to answer?
Submit
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