Street Address Line 2
State / Province
Postal / Zip Code
Current body fat percentage , if known.
How often do you currently work out?
What is your occupation?
What type of exercise do you like most?
How many days can you commit to exercise and honestly stick to?
Do you have a gym membership?
If So, what gym do you belong to?
Do you prefer workouts that are at a gym, or at home? Or prefer a combo of both?
What are your body goals? Check all that apply.
Tighten up and Tone
Build lean muscle but not bulk
Gain Strength and mobility
Build a booty
Lose Fat percentage
What are your current eating habits? Do you skip meals? Have a problem with over eating, binge eating, weekend eating? Be specific
What type of diets have you tried in the past, and what type of results did you get?
How often do you eat out in a week? Which meals do find you eat out most?
How much water would you say you drink per day?
How many sodas do you drink per day? Put the # and if you drink diet or regular
What would you say is your most unhealthy habit ?
Do you have any medical issues or injuries I should know about before planning your work outs?
What are some things that you want to change, some short term goals to set and work on?
What are some long term goals you want to work on?
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