QUESTIONAIRE

In order for me to build and tailor your training program and nutritional plan as specifically as possible for you and your needs, I need you to take a few minutes to fill out the questionnaire in as much detail as possible about your current and previous training history and future goals.

NAME

First Name

Last Name

DATE OF BIRTH

YYYY

GENDER

MALE

FEMALE

PHONE NUMBER

EMAIL ADDRESS

OCCUPATION

WEIGHT (IN KG)

WAIST (AROUND THE BELLY BUTTON IN INCHES)

MEN -CHEST AT THE LARGEST POINT - LADIES - HIPS

LEFT ARM (AT THE LARGEST POINT IN INCHES)

THIGH (AT THE LARGEST POINT IN INCHES)

HAVE YOU DONE ANY EXERCISE RECENTLY

Option One

Option Two

IF YES, WHAT HAVE YOU BEEN DOING?

GIVE ME DETAILS OF YOUR SHORT TERM GOALS

PLEASE LIST YOUR LONG TERM GOALS

HOW MANY TIMES A WEEK DO YOU PERFORM THESE EXRERCISES?

WHAT RESISTANCE EXERCISE HAVE YOU BEEN PERFORMING, GO INTO DETAIL PLEASE, TRAINING SPLIT, EXERCISES, SETS AND REPS?

HOW MANY TIMES PER WEEK DO YOU PERFORM CARDIOVASCULAR EXERCISE?

WHAT CARDIOVASCULAR TRAINING HAVE YOU BEEN DOING, GO INTO DETAIL - TIME, INTENSITY AND TYPE?

HAVE YOU GOT ANY INJURIES THAT I NEED TO BE AWARE OF BEFORE DESIGNING YOUR PROGRAM?

YES

F YES WHAT INJURIES DO YOU HAVE?

GIVE ME AN EXACT 2 DAY FOOD DIARY, LIST EVERYTHING SINGLE THING EATEN AND DRUNK WITH EXACT AMOUNTS AND TIMES-

DO YOU HAVE ANY FOOD ALLERGIES OR ARE THERE CERTAIN FOODS THAT YOU JUST CANNOT STOMACH?

HOW MANY UNITS OF ALCOHOL DO YOU CONSUME EACH WEEK?

DO YOU USE SUPPLEMENTS?

YES

IF YES WHAT SUPPLEMENTS DO YOU USE?