Personal InformationFirst Name *Last NameEmail Address *Gender *SelectMaleFemaleHeight *Weight *Occupation *Current lifestyle *SelectSedentaryModerately ActiveVery ActiveGoalWhat is your ideal weight? *What is your fitness goal for the next 6-8 weeks? *What is your fitness goal for the next year?Medical HistoryDo you have any pre-existing medical conditions (e.g., diabetes, hypertension, heart disease, arthritis)? *YesNoIf yes, please specify. *Have you had any surgeries in the past? *YesNoIf yes, please specify. *Are you currently taking any medications? *YesNoIf yes, please specify. *Physical ActivityHow many hours of sleep do you get each night *SelectLess than 6 hours6-8 hoursMore than 8 hoursWhat time you typically wake up and go to sleep? *How many days per week do you exercise for at least 30 minutes? *Select0-1 day2-3 days4-5 days6-7 daysWhat types of exercise do you currently engage in? *SelectCardiovascularStrength trainingFlexibility trainingNoneDescribe a typical workout *What are your fitness goals *SelectWeight LossMuscle GainImproved Cardiovascular HealthPerformance For a Specific SportPerformance for a specific sport *NutritionWhat is your typical daily calorie intake? *Do you have any food allergies or intolerances? *YesNoPlease list any food allergies or intolerances you may have *What is your usual dietary pattern ? *How often do you eat fast food or processed food? *How many servings of fruits and vegetables do you eat per day? *Do you take any dietary supplements? *YesNoPlease indicate the dietary supplements you are currently taking *Describe what you would eat and drink in a typical day including time. *Lifestyle HabitsDo you smoke or consume alcohol? *YesNoPlease specify *How many hours of sleep do you get per night?Hours-000102030405060708091011121314151617181920212223Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859How many liters of water do you consume daily? *How often do you experience stress? *SelectRarelyOccasionallyOftenVery oftenConstantlyAdditional CommentsIs there anything else you would like to add that may affect your health and wellness?Send MessagePlease do not fill in this field.
