Getting To Know You Name* First Last Phone*Email* Home Mailing AddressThis will help with time zone issues Date of Birth* Month Day Year Current Age*Please enter a number from 18 to 99.Occupation*Experience and GoalsThis is where I will gain a firm understanding of your experience level to help me assess training programming, along with what your specific goals are. Give me a detailed description of your goals (fat loss, muscle gain, compete, target areas, timeline). For the most part, fat loss and muscle gain are separate goals so please choose only one.*What's your "why" for your answer above? This is important. Take a moment to think deeply about it. If/when you hit a roadblock, we're going to revisit this.*How many years of exercise experience do you have?* None Less than a year 1-3 years 3-6 years More than 6 years Training ExperienceWhat is your current training regimen like (if any)? And how you feel it is working for you.What fitness programs have you followed in the past (if any)? Why did they work or not work for you?What equipment do you have access to? Please be as specific as possible. For example, if you have dumbbells, please list all of the weights that you have. If none, please list "no equipment".Do you live in an area where you can go for a walk or run outside? Yes No List your favorite exercises from the past:List any exercises to avoid in your programPlease list any prior or current injuries that may affect your workout program.How many days per week are you currently training?*1234567I don't knowHow many days per week are you willing to train? (Note - if you're unsure, please choose I don't know)1234567I don't knowBased on the above question, please choose your prefered workout days based on your lifestyle. Monday Tuesday Wednesday Thursday Friday Saturday Sunday How many steps would you say you average per day?*Also how many hours would you say are spent sitting?Nutritional InformationWhat is your height*What is your current weight?*Please use a scale, no guesstimating!Have you ever tracked your food before using MyFitnessPal?*If the answer is no, you can skip the next two questions.If you know your current macronutrient intake breakdown, please provide the amounts of Fats/Carbs/Protein. If you don't know the macros, try to give me an estimated daily calorie intake. If you are not sure, I'd prefer you to say "N/A" than taking a wild guess. This will only help if you're fairly sure and specific.Do you know where your maintenance calories are? If no, we'll determine this together, just list "N/A"How long have you been dieting, and what diets have you been using? (If you haven't been dieting, type "N/A")*Please give me a brief description of your diet history, including diets you’ve tried, for how long, and what was the outcome? Tell me specifically about the past 5 years.In regards to your current food intake, have you been gaining, losing, or relatively maintaining your weight?Indicate your activity level below. This is to determine your non-exercise related energy expenditure, on top of exercise itself. Basically, how active you are during the time away from working out.* Sedentary (Appropriate for those who work at a desk job AND are sedentary at home) Lightly active (Appropriate for most people with young children, who are otherwise sedentary; Many who have a desk job but exercise occasionally; Those who stand a lot at work, but don’t really walk around a lot or lift heavy items) Active (Appropriate for those who have an active job (nurses, waitresses, laborers, etc)) Very Active (Appropriate for those who have a very active job (trainers, some laborers, some athletes, some warehouse workers)) Medications and Supplements.*List any current supplements or doctor prescribed medications that you are taking. PLEASE LIST EVERYTHING- this will only stay between us, and it is important for me to know every piece of information.If you have been tested for or know of any food related sensitivities or allergies, please list them below.Any other information that you could provide that you feel would be vitally important in your program design please list below.Please describe your current level of stress environment. Be as detailed as you are comfortable.Please rate your overall daily stress on a (1-10 Scale). No stress at all, I'm like, totally chill dude 1 2 3 4 5 6 7 8 9 10 I'm thinking about burning the world down Normal Eating Habits*Please describe a normal day of eating for you on 1 week day and 1 weekend day.Water*How much water, in ounces, would you estimate you drink per day?Daily Schedule*Please list your typical week day and weekend schedules to help with planning meal and snack times.Willingness to be prepared*Are you willing to grocery shop, cook, and make sure you have food readily available? It can be prepared food, but you will need to be responsible for meeting your food needs daily, and planning ahead.Favorite Foods*List your favorite foods that you love to eat daily.Foods you HATE!*Please tell what foods you will never eat!Trigger Foods*Do you have any trigger foods or what I like to call no limits foods? If it’s in your house, you will eat it ALL.What is your relationship to alcohol?*Do you smoke?* Yes No I consider myselfCheck all that apply. a Stress Eater an Emotional Eater a Binge Eater Do you use food for comfort or reward?* Yes No Can you tell if you’re hungry or not?* Yes No Can you tell when you’re satisfied?*Can you tell when you’re satisfied? Or do you like to be FULL? How comfortable are you leaving food on your plate?MindsetI need to learn how your brain works.Please check off all the boxes that you agree with.* People have a certain amount of intelligence, and there isn't any way to change it. No matter who you are, there isn't much you can do to improve your basic abilities and personality. People are capable of changing who they are. You can learn new things and improve your intelligence. People either have particular talents, or they don't. You can't just acquire talent for things like music, writing, art, or athletics. Studying, working hard, and practicing new skills are all ways to develop new talents and abilities. SleepAfter waking up in the morning, could you fall back asleep at ten or eleven a.m.?* Yes No Maybe Can you function normally without caffeine before noon?* Yes No Maybe On a scale of 1-10 how would you rank your sleep quality?*1 is tossing and turning, 10 is sleeping like a baby12345678910How many hours of sleep do you normally get per night?*12345678910Comments, Questions or Feedback?Share additional comments, questions or feedback.