Form Please enable JavaScript in your browser to complete this form. - Step 1 of 4Personal InformationDateName *FirstLastGender *MaleFemaleAge *Height *Weight *Phone NumberEmail *Next Lifestyle InformationWhat do you do for a living?How much would you rate your level of physical activity at work? *1 (not active)2345 (very active)Do you follow a regular working schedule, do you work days, afternoon or nights?How often do you travel?RarelyA few times a yearA few times a monthWeeklyPlease list the physical activities that you participate in outside of the gym and outside of work:NextMedical and health informationIf you have any diagnosed health problems list the condition(s).If you are on any medications, please list them.What additional therapies are being undertaken for the given health problem(s)?If you have any injuries, please list them.What additional therapies are being undertaken for the given injury?Are you experiencing any stresses or motivational problems? *YesNoHas anyone of your immediate family developed heart disease before the age of 60 ? *YesNoDo any diseases run in your family ? *YesNoIf yes please list:Do you suffer from diabetes, asthma, high or low blood pressure ? *YesNoIf yes please list :Do you smoke ? *YesNoYour current diet could be best characterized as : *low-fatlow-carbhigh-proteinVegetarian/VeganNo special dietNextGoalsOn a scale from 1-10 how motivated are you to make changes ? *1 (not motivated)2345678910 ( Extremely motivated)Checkboxes *Improved healthImproved enduranceIncreased energyIncreased strengthIncreased muscle massFat lossImproved moodWhat is your main goal regarding your training ? Short term and long term goal *What is your main goal regarding your health and well-being? *Do you have injuries, allergies or intolerances? If yes please elaborate *Timeline to achieve goal : *8 weeks16 weeks24 weeks32 weeks40 weeks1 yearHow often are you currently training ? *1234567How often are you willing to train a week to reach your goal ? *1234567Have you trained with a personal trainer before? *YesNoIf yes what kind of training did you do:What is the best time for you to train ? *MorningMid-DayAfternoonEveningAnyPhoneSubmit