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"I'm
in the best
shape of my
life!" Are you
a busy
executive or
owner of
your own
business,
but have
found that
your travels
and the
daily grind
of running
your
business
have taken
away your
desire to
work out,
and more
importantly
your time?
My Fitness
Profile
1 of 7-
Personal Profile Information
[required]
* Name:
*
Address:
*
City:
*
State:
*
Zip/Post
code:
*
Phone
number & best time to call
*
E-mail:
Gender
Male
Female
Birth Date:
Weight:
Body
fat %:
%
Height:
How
did you find us?
2 of 7- Which
Best Describes Your Individual Needs?
[required]
Increase Motivation
Decrease Body Fat
Decrease Risk of Injury
Increase Muscle & Strength
Increase Energy & Stamina
Rehabilitate an Injury
Decrease Stress & Anxiety
Accelerate Results
Individualize Course of Action
Insure Continual Progress
Insure Accountability
Improve Health & Appeal
Improve Existing Training Program
Learn & have more... Fun!
Other:
What
services do you want a trainer to provide?
Diet/Weight Management
Fitness Coach
Stress Management
Fitness Evaluation
Risk Management
Training Program Design
Fitness & Nutrition Counseling
Sport-Specific Preparation
Private Training Sessions
Injury Recovery
Group Training Sessions
Workout Supervision
Prep for a Bodybuilding Show
Prep for a Fitness Show
Other:
How
often would you like to meet with your trainer?
Where
would you like to train?
What
time would you like to train?
Do
you prefer a male or female trainer?
Male
Female
No Preference
When
would you like to begin training?
Monthly
Investment :
Additional
Details:
3 of 7- Body
Type. Which Best Describes You?
[required]
I
can eat anything I want and I have a hard time gaining weight.
I can lose or gain weight by adjusting my activity level and eating habits.
I find it difficult to lose weight. I can gain weight easily and have to watch what I eat.
4 of 7- Health &
Medical Conditions
[required]
No. I do not have any medical conditions
Yes. I have a medical
conditions. I have provided information regarding my condition below.
5 of 7- Daily
Life Questions [required]
What
time do you normally wake up?
What
time do you normally go to bed at night?
If
you smoke, how many years have you smoked?
If
you drink alcoholic beverages, what kind and how many
per day?
Are
you allergic to any types or kinds of foods? If
so, what are they?
Have
you ever been placed on any type of nutritional program in the past?
Yes
No
If
yes, by whom and what did it consist of?
What
were your results?
6 of 7- Weekly Exercise Information
[required]
Explain
in detail what type of resistance exercises, cardiovascular
or sports activities you perform on average during
a 7-day period. Please also provide the
frequency and duration of these activities.
Activity
Days
Duration
(min):
How
would you rate the activity level of your profession,
or what you do during the day (non-exercise related).
Sedentary
Moderately
Active
Active
Very
Active
7 of 7- Food
Record [required]
Please
describe what you eat on a daily average. Include
portion sizes (e.g., small, medium, large) any drinks
or snacks and vitamins or supplements. Provide
as much detail as you like.
Food/Beverage
and amount
Time
of Day
Make a list of
your Favorite Foods:
Make a list of
foods that you dislike:
Finished
Press the Submit button to forward
your profile information to one of our consultants.
