Re-Enter Your Full Name:

Re-Enter Your E-mail address:

Phone Number:

Postal Mail Address:

Age:     Male or female:     Height:     Bodyweight:

What is your main fitness goal that you would like to achieve in the next 6 months:

If you could wave a magic wand and have your ideal body, what would it be like:
(please be specific)

What are your biggest fears and frustrations with working out and getting in shape:

What do you need the most assistance with to help you achieve your fitness goals:

How long have you been working out:

How many days per week do you workout:

What exercise equipment to you have available: (home gym, commercial gym, etc.)

What is your daily schedule like: (what times can you workout, etc.)

Sample weight training routine: (bodyparts trained, sets, reps, length of session, etc.)

Sample cardio training routine: (type of exercise, length of session, etc.)

Example of typical weekday eating: (when do you eat, what foods, how much, etc.)

Example of typical weekend eating: (when do you eat, what foods, how much, etc.)

Do you smoke or drink alcohol: (if so how much, how often, etc.)

List any vitamins or supplements that you are currently taking:

List any food allergies or food dislikes: