Full Name
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Mobile Number
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Email Address
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How did you hear about us or whom has referred you ?
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Stats
Your Age
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Height (ex: 5 feet, 5 inch)
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Current Weight (in pounds)
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Lowest Ever Weight (in pounds)
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Highest Ever Weight (in pounds)
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Where do you carry stubborn/hard to lose body fat? (ex: lower abdomen, flanks/love handles, under arm, etc.)
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Goals, Challenges and Your WHY
What are your health and fitness goal and what really inspires and motivates you to achieve these goals?
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Do you have a specific timeline to achieve your results ?
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Are there emotions you go through when thinking about getting help with your health and fitness goals?
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What are the biggest obstacles you face in trying to achieve your goals?
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What are your reasons for wanting this change?
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General Health
Have you ever felt any difficulties relating to food in general?
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Do you have any current or past medical issues that would limit your physical activities or nutrition?
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Schedule and Habits
What do you believe is your WORST habit regarding your health?
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What do you believe is your BEST habit regarding your health?
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What time do you go to bed?
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What time do you wake up?
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Detail your average daily schedule
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Nutrition Info
Please outline your average day regarding nutrition? Include the time of day you eat and how much of each food you consume.
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Do you take any supplements? If so, list them by name and when you take them. (ex: BCAA's, Glutamine, Multi Vitamin, etc.)
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Do you have any known/suspect food sensitivities or allergies? If so, list them.
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How much water do you drink daily?
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List the foods that you like
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List the foods that you absolutely don't like and would not want to be a part of your nutrition plan.
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When and What do you crave the most?
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What kind of physical activities do you do? (ex: weight training, running, yoga, etc.)
Do you have any experience working with Free Weights?
What are some of your weaker lifts?
What are some of your stronger lifts?
How much time do you have to train each day and week?
What time of day do you workout or prefer to workout?
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Please note anything else that you feel would be important for us to know about you and what you want to achieve. (Everything from eating disorders to past contest history. Don't hold anything back. All your information remains private and confidential.)
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