General Information

First Name *

Last Name *

Height *

Current Body Weight *

Age *

Current Occupation *

Address *

Experience & Goals

This is where we will gain a firm understaning of your experinece level to help us assess training programming, along with what your specific goals are

Give us 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. *

Training/Cardio Information

What is your current training regimen like? Please include split, and how you feel it is working for you. *

What access do you have in terms of cardio equipment available? Do you live in an area where you can go on a walk in the morning? *

What type of cardio do you prefer? *

LISS - Low Intensity Steady State (Treadmill walk, elliptical, stepper, Jog, etc....)

HIIT - High Intensity Interval Training - Circuits - much more intense/ higher heart rate, shorter duration

Screw Cardio Seriously - Would rather not....

List any exercises to avoid in the design of your program *

Do you have access to a full gym? *

Yes

If you answered no, what equipment do you have access to - Please list (for example: Squat Rack, Barbells, Hammer Strength Machines, Dumbells, Spin Bike Etc)

How many days per week are you willing to train? *

Nutritional Information

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 your fairly sure and specific.

In regards to your current food intake, have you been gaining, losing, or relatively maintaining your weight? *

Do you know where your maintenance calories are? If no, we'll determine this together, just list N/A

Indicate your activity level below. This is to determine your non exercise related energy expenditure, on top of lifting. Basically, how active you are during the time away from the gym. *

Sedentary plus 3-6 days of weight lifting

Lightly active, plus 3-6 days of weight lifting

Active plus 3-6 days of weight lifting

Very active plus 3-6 days of weight lifting.

Body Fat Example Scale:

Based on the photo above, estimate your current body fat percentage *

How many untracked/ "cheat" or free meals are you currently having on a weekly basis? *

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 regarding AAS, or any other medications your using. *

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.

Do you have a regular menstrual cycle? If not, please explain. If so, are your on birth control?

On a scale of 1-10 how would you rank your sleep quality? *

Please describe your current level of stress environment on a scale from 1-10. (1 being no stress, 10 being constantly about to explode) *