Free 15 Minute Consultation

Name *

Email Address *

Phone Number *

+1

Date of Birth

Goals *

Occupation

Body Height

Body Weight

Current Fitness Conditions & Goals

Preferred workout days and time:

Fitness Goal:

List any exercise you are currently doing:

List previous surgeries if any:

List any type of actual pain or discomfort:

List any medical conditions if any:

List any drugs or medications you are currently taking:

Fitness Habits

How many OZ of water do you drink per day?

Do you drink alcohol? What type? How often?

Do you crave carbohydrates & sugars?

Yes

No

Do you smoke?

Yes

No

Do you eat before and after training?

Yes

No

Are you taking any supplements? If so, please specify brand, supplements amounts and dosage.

How many hours per day do you usually sleep?

At what time do you usually go to sleep?

At what time do you wake up?

Do you feel tired when you wake up?

Yes

No

Are you tired during the day?

Yes

No

How would you rate your stress level?

Low

Medium

High

Sample of Diet

Breakfast – time and typical food you eat

Morning Snack – time and typical food you eat

Lunch – time and typical food you eat

Dinner – time and typical food you eat

Afternoon Snack – time and typical food you eat

Any final comments or special request for the consultation?

I agree with the terms of service

Today your life changes for the better!