Personal Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age
*
Height in cm
*
Weight
*
Instagram handle?
*
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Training & Movement
How many days per week can you consistently commit to training?
*
Which days/times typically work best for your schedule?
*
Do you prefer training at a gym or home?
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Are there any current injuries or physical limitations I should be aware of?
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Are there specific exercises or movements you find challenging or uncomfortable?
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Do you track your daily steps? If so, what method do you use (smartwatch, app, etc.)?
*
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Nutrition & Food Preferences
Do you have any food allergies or intolerances?
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Are there any dietary preferences or restrictions I should consider? (e.g., vegetarian, dairy-free, gluten-free)
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What does a typical day of eating look like for you?
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How often do you eat out or order takeaway in a typical week?
*
Are there any foods you dislike or prefer not to include in your plan?
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How often do you cook at home? Do you enjoy preparing meals?
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Do you follow a specific eating schedule (e.g., intermittent fasting, three structured meals perday)?
*
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Your Mindset Around Food
Do you experience challenges with emotional eating, cravings, or inconsistent eating habits?
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Have you followed any particular diets in the past? What was your experience?
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How do you feel about your current approach to nutrition?
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What is your biggest struggle when it comes to food and eating habits? (e.g., portion control,late-night snacking, meal consistency)
*
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Lifestyle & Routine
How would you describe your daily activity level? (Mostly sedentary, lightly active, moderatelyactive, very active)
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Does your job require mostly desk work, physical movement, or a mix of both?
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How many hours of sleep do you typically get per night?
*
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Health & Medical Background
Have you ever been diagnosed with a heart condition, suffered a stroke, or been advised to take precautions with exercise?
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Yes
No
Do you ever experience chest pain, dizziness, or shortness of breath during physical activity?
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Yes
No
Have you had an asthma attack in the last 12 months that required medical attention?
*
Yes
No
Do you have diabetes or any condition that affects blood sugar regulation?
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Do you have diabetes or any condition that affects blood sugar regulation?
*
Yes
No
Are there any medical concerns or conditions that may impact your training or nutrition?
*
Yes
No
Have you recently been pregnant or given birth within the last 12 months?
*
Yes
No
Are you currently taking any medications or supplements that might influence your program?
*
Yes
No
If you answered yes to any of the above, please provide details:
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