Questionnaire Phone First Name * Last Name * Email Address * Phone Number * Age * Height (feet/inches) * Weight (lbs) * Mailing Address * Medical Issues What would you like to achieve? When would you like to achieve this by? Training History How long have you been following your current regime/program? How long since you started training on a regular basis? Any previous issues injuries, aches, pains or ‘niggles’? If so, be specific. List any - Medical History / Medication Diet & Nutritional History How long have you been on your current diet? What diets have you tried in the past? If you’ve been on diets previously, what did you find MOST successful and easy to maintain? Are you allergic to any foods? Are you aware of any food intolerance you may have? List any foods that you dislike and would not eat: Describe Your Daily Meal Plan Below Example: Meal 1 = Please list your normal breakfast (For example: 8am - 3 eggs, 2 toast, 11am - 30g nuts etc) Meal 1 (Typically Breakfast) Meal 2 = Please list your next meal/snack and the time Your answer Meal 3 = Please list your next meal/snack and the time Your answer Meal 4 = Please list your next meal/snack and the time Your answer About You Please describe your physique. What do you do for a job? How active is it? How stressful is it? Do you have to take work home and complete in the evenings or weekends? Sleep How many hours sleep do you get per night? Do you fall asleep easily? Do you wake in the night at all? If so what time and why? Do you take any sleep aids or supplements before bed? Supplements Do you currently take supplements? Yes No Do you take any supplements just before, during or immediately after your workout? Exercise Do you currently train/exercise? Yes No How many times per week do you consistently exercise for? Please list the type and time spent training on each day e.g. Monday: 60 minutes fasted running, Tuesday 90 minutes resistance training on Back & Biceps, etc. Where do you train? At Home or A Small Gym (Neighborhood community center, work, etc.) A Large Gym Cross-Fit Gym Outside If there was an optimal amount of training sessions and time we could give you what would your upper limit be? e.g. I could train up to 5 times a week for 60-70 minutes maximum per session What is your favorite type of training? Do you like heavy weight training, run- ning, other cardio training, body-weight work, circuit training or other classes If your preferred type of training is not optimal to achieve your goals, would you be willing to change and do whatever is the most optimal? How many times a week do you train each muscle?
