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New Client Questionnaire
First AND last name
*
Email
*
Phone
How old are you?
*
Weight
*
Goal
*
Height
*
Gender
*
Are you currently on any medications? if so, please list
*
What do you want to change? Pick 3
*
Weight loss
Fat loss
Improve physical fitness
Gain weight
Look better
Get Stronger
Improved energy
Gain Muscle
Physique Competition
Pass physical test
Of the goals you selected, which is most important to you right now?
*
Which days are you generally available to train?
*
What times are you generally available to train?
*
On average how much sleep do you get?
*
What is your average daily step count ?
*
What is your current calorie intake or current macros?
*
On average do you eat....
*
Breakfast
Lunch
Dinner
Snacks
Dessert
On average do you drink....
*
Soda
Juice
Alcohol
None of the above
Dietary Preferences
*
Anything
Vegan
Vegetarian
Paleo
Mediterranean
Keto
Intermittent fasting
Cooking Abilities
*
Microwave
Baking
Grilling
Cooking
Has experience with meal prep
On average how many times a week do you eat out?
*
1x a week
2x a week
3x a week
4x week
5x week
6x week
7x week
More than 7x times a week
Any food allergies?
*
Do you have a food scale?
*
Yes
No but I will get one from: https://a.co/d/1ZHBhaE
Please list foods you enjoy eating
*
Please list foods you strongly dislike:
*
Do you have any previous exercise experience?
*
0 - 6 months
6 months - 1 year
1 - 2 years
2 + years
Where did you learn about my services?
*
Google
Thumbtack
Instagram
Facebook
Bruceton Wellness Patient
Word of Mouth
Other
Submit
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