|
Your Name (required)
|
|
|
Your Email (required)
|
|
|
Phone Number
|
|
|
Your Date of Birth
|
|
|
Your Body Weight
|
|
|
Your Height (Feet, Inches)
|
|
|
Waist Measurement (at Belly Button)
|
|
|
Hip Measurement (widest point around glutes)
|
|
|
What are your primary training / fitness goals?
|
|
|
Average Hours of Sleep Per Night
|
|
|
How long have you been strength training?
|
|
|
What are your primary physical activities or sports?
|
|
|
What type of work do you do? (ie: Mostly sitting, standing, walking, lifting? Schedule?)
|
|
|
Based on your schedule, how many days per week can you train / workout?
|
|
|
List and describe any injuries you have
|
|
|
List any other relevant health issues (ie: heart, blood pressure)
|
|
|
List and describe any exercises / movements you find uncomfortable or painful
|
|
|
How many full range bodyweight chin ups can you perform?
|
|
|
How many full range bodyweight parallel bar dips can you perform?
|
|
|
Where do you usually train (or plan on training)? Ie: fitness club, home gym, etc.
|
|
|
What exercise equipment do you have access to?
|
|
|
Briefly Describe Your Current Physical Exercise / Workout Routine
|
|
|
How many servings of fruits or vegetables do you eat daily?
|
|
|
How many servings of protein foods (ie: meat, fish, poultry, eggs, dairy) do you eat daily?
|
|
|
How many servings of carbohydrate foods (ie: potatoes, pasta, rice, bread, etc) do you eat daily?
|
|
|
Do you consume a source of healthy fat daily (ie: fish oil, nuts, avocado, olive oil)?
|
|
|
How many times do you eat daily?
|
|
|
Briefly Describe Your Current Nutrition Habits
|
|
|
Briefly List Your Food Preferences (Likes / Dislikes)
|
|
|
List Any Supplements you Take Regularly
|
|
|
Any Comments / Questions?
|
|
|
By clicking on the "Send" button below, you agree to release and forever discharge Top Form Fitness and your online coach Josh Hewett (known herein as the ‘Releasees’) from any and all liabilities, claims, actions, damages, costs or expenses of any nature whatsoever, whether in law or equity, that you have ever had, or may have against any of the Releasees arising out of or in any way related, directly or indirectly, to participation in any of our online training programs and other related activities. You, the participant, agree to assume all risks incidental to such participation:
Yes, I AgreeNo
|
|
|
|
