Need Help With Macros

1

Your Name* This field is required.

First Name

Last Name

2

What is your gender?* This field is required.

Female

Male

3

E-mail Address* This field is required.

4

What is your cell?* This field is required.

Area Code

Phone Number

5

How old will you be on your next birthday?* This field is required.

6

Can you tell us where you found us/this form please?* This field is required.

7

What is your height?* This field is required.

8

What is your current weight?* This field is required.

9

I want to?* This field is required.

Lose Body fat (lose weight)

Build Muscle (not lose weight)

Increase Performance (maintain weight)

Improve My Health (maintain weight)

10

How many hours do you exercise per week?* This field is required.

1-3

3-5

5-7

7+

11

Exercise notes

12

Do you have any food allergies?* This field is required.

YESNO

13

Please list your food allergies* This field is required.

14

Do you have any medical conditions?* This field is required.

YESNO

15

Please list your medical conditions* This field is required.

17

How Many Alcoholic Drinks Per Week ?* This field is required.

>8 drinks per week

4-7 drinks per week

1-3 drinks per week

None I don't drink

18

Have you lost/gained more than 20lb in the last 2yrs?* This field is required.

YESNO

19

Tell us about that weight regain. Were you on a diet and rebounded or was the weight loss due to stress/poor health?* This field is required.

20

Are you a PLT Members Club Client?* This field is required.

YESNO