Before We Begin...

Complete This Survey First!

(Only questions with the * mark are mandatory)

First Name *

Last Name *

Phone Number *

Email *

How much do you weigh?

How much weight do you need to lose?

What is your fitness goal?

Have you tried to reach this goal before?

Yes

No

If the answer is yes, explain what you have tried. What has worked and what has not?

What type of physical activity do you do regularly, if any?

What type of physical activity do you like?

Do you suffer from any medical condition?

Is your job stressful?

Yes

No

How much sleep do you get per day?

What would your perfect fitness program look like?

What do you usually eat in a 24 hour period?

Are you a smoker?

Yes

No

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