BUILD A BETTER YOU
Name: Date (mm/dd/yy):
D.O.B (mm/dd/yy): Gender: ---MaleFemale Telephone:
What are your fitness goal(s)?
What is your current weight? Do you smoke? ---YesNo
Do you drink? ---YesNo Do you drink soda / energy drinks? ---YesNo
Do you drink coffee? ---YesNo Are you currently doing any type of exercise? ---YesNo
Have you ever participated in the training program? ---YesNo
Have you ever worked with a Nutritionist or Certified Personal Trainer? ---YesNo
How would you rate your motivation towards training (5 being the highest)? ---12345
Realistically, how many days are you available to exercise per week?
What is the timeframe to reach your fitness goal?