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New Member Questionnaire
Personal Information
Full Name
Email
Phone Number
Age
Height
Current Body Weight (in lbs)
Occupation
Address
Are you married/significant other? Do you have any kids?
What are some of your favorite hobbies and activities? (hiking, watching football, playing with your kids, etc.)
Experience and Goals
Give us a detailed description of your goals (fat loss, muscle gain, compete, target areas, timeline). For the most part fat loss and muscle gain are separate goals so please choose only one.
How many years of exercise experience do you have?
*
None
Less than 1 year
1-3 years
3-6 years
More than 6 years
What is your current training regimen like? How do you feel it is working for you?
Do you have access to a full gym?
*
Yes
No
If you answered no, what equipment do you have access to - Please list (for example: Squat Rack, Barbells, Hammer Strength Machines, Dumbells, Spin Bike, etc)
List your favorite exercises from the past.
Please list any prior or current injuries that may affect your workout program.
List any exercises to avoid in the design of your program.
How many days per week are you currently training?
*
0
1
2
3
4
5
6
7
How many days per week are you willing to train? (Note - if you're unsure, please choose I don't know)
*
0
1
2
3
4
5
6
7
Based on the above question, please choose your preferred workout days based on your lifestyle.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Nutritional Information
Have you ever tracked your food before using MyFitnessPal? *If the answer is no, you can skip the next two questions.
*
Yes
No
If you know your current macronutrient intake breakdown, please provide the amounts of Fats/Carbs/Protein. If you don't know the macros, try to give me an estimated daily calorie intake. If you are not sure, I'd prefer you to say "N/A" than taking a wild guess. This will only help if your fairly sure and specific.
Do you know where your maintenance calories are? If no, we'll determine this together, just list "N/A"
In regards to your current food intake, have you been gaining, losing, or relatively maintaining your weight?
Body Fat Example Scale
Based on the photo above, estimate your current body fat percentage.
List any current supplements or doctor prescribed medications that you are taking. PLEASE LIST EVERYTHING- this will only stay between us, and it is important for me to know every piece of information or any other medications your using.
If you have been tested for or know of any food related sensitivities or allergies, please list them below.
How often do you drink alchol
*
I don't
1-2 times a week
2-3 times a week
3-4 times a week
Too much
Any other information that you could provide that you feel would be vitally important in your program design please list below.
Please rate your overall daily stress
*
Cool as a cumcumber
1
2
3
4
5
6
7
8
9
Burn it all down
How many hours of sleep do you typically get each night?
*
0
1
2
3
4
5
6
7
8
9
10
Submit
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