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18
Questions
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1
What is your name, age, height, gender?
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2
What is your email?
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3
What is your first goal and what you hope to get out of this program?
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4
Any secondary goals?
Short explanation
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5
What is your profession?
Ex. Do you sit at a desk all day? Do you lift heavy things at work? Etc
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6
What is your daily activity level?
Please Select
Sedentary (0-1 hours of exercise per week)
Pretty active (2-4 hours of activity per week)
Active (5-8 hours of exercise per week)
Very active (8+ hours per week)
Please Select
Please Select
Sedentary (0-1 hours of exercise per week)
Pretty active (2-4 hours of activity per week)
Active (5-8 hours of exercise per week)
Very active (8+ hours per week)
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7
Is your digestion normal?
YES
NO
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8
How many hours of sleep do you get on average?
Less than 4
4-5
5-6
6-7
7+ hours per night
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9
Explain a day of eating
Ex. Wakeup and eat two pieces of toast and a coffee, lunch around noon usually a wrap....state post and pre workout meals if any.
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10
What time of day do you workout?
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11
Do you have any injuries or limitations?
If so, explain.
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12
Rate your daily hydration out of 10
1=bad 10=hydrated ✅
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13
Rate your daily stress levels out of 10
1=chill and calm 10=very stressed
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14
Are there any exercises that you dislike? Any that you specifically love?
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15
Any foods you dislike? Any allergies?
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16
Current weight
In lbs please 🙏🏻
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17
Date
Choose a date for a consult call
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Date
Year
Month
Day
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18
How would you like me to contact you?
Phone? Email? Instagram? WhatsApp etc?
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