Fitness Plan Questionnaire
Name
*
First Name
Last Name
Email
*
example@example.com
Sex
*
Please Select
Male
Female
Age
*
Please Select
18 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70+
Weight (lbs)
*
Please Select
100
105
110
115
120
125
130
135
140
145
150
155
160
165
170
175
180
185
190
195
200
205
210
215
220
225
230
235
240
245
250
255
260
265
270
275
280
285
290
295
300
305
310
315
320
325
330
335
340
345
350
355
360
365
370
375
380
385
390
395
400
400+
Height (ft/in)
Please Select
5' 0"
5' 1"
5' 2"
5' 3"
5' 4"
5' 5"
5' 6"
5' 7"
5' 8"
5' 9"
5' 10"
5' 11"
6' 0"
6' 1"
6' 2"
6' 3"
6' 4"
6' 5"
6' 6"
Current Fitness Level
*
Please Select
Beginner
Intermediate
Advanced
Current Diet
Please Select
None
Keto
Paleo
Vegetarian
Vegan
Carnivore
Low-Carb
Whole30
Gluten-Free
Number of Workout Days (per week)
*
Please Select
1
2
3
4
5
6
Preferred Time of Day
Please Select
Morning
Afternoon
Evening
Night
Workout Location
Please Select
Home
Gym
Equipment Available? (Home)
Please Select
None
Dumbbells
Free weights
Universal Machine
Resistance Bands
Medically Approved?
*
Please Select
Yes
No
Medical Restrictions
Past Injuries
Dietary Restrictions
Vitamins / Supplements
Additional Information
Submit
Should be Empty: