* First Name:
*
Last Name:
* Your Email Address:
*
Birth Date:
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* Gender:
-- Please Select --
Male
Female
*
City:
* State:
*
Occupation:
* Height (ft/in):
* Weight (lbs):
* What is your
fitness level?
-- Please Select --
Beginner
Intermediate
Advanced
* What is your
primary fitness goal?
-- Please Select --
Lose fat (weight
loss)
Build lean
muscle (bulk up)
Both
(drop fat/build lean muscle)
* What is the
biggest problem area on your body?
-- Please Select --
Stomach
Hips/Thighs
Butt
* What type of
weight training do you do?
-- Please Select --
Free Weights
Machines
Both
I Don't
Weight Train
* How many days
per week do you weight train?
-- Please Select --
1-2 Times/Week
3-4 Times/Week
5-6 Times/Week
Everyday
I Don't
Weight Train
* What is your
average rep/set range?
-- Please Select --
High Reps/High Sets
High Reps/Low Sets
Low Reps/High Sets
Low Reps/Low Sets
Med Reps/Med Sets
I Don't
Weight Train
* Do you train
each set to positive failure?
-- Please Select --
Yes
No
* What time of
day do you weight train?
-- Please Select --
Morning
Afternoon
Evening
I Don't
Weight Train
* What supplements
do you take before training?
* What supplements
do you take after training?
* Do you change
exercises between sessions?
-- Please Select --
Yes
No
* How many days
of rest between muscles groups?
-- Please Select --
1-2 Days
3-4 Days
5-6 Days
Over 6 Days
I Don't
Weight Train
* Do you keep
a journal of your training sessions?
-- Please Select --
Yes
No
* What is your
primary type of cardio training?
-- Please Select --
Running/Jogging
Walking
Elliptical Trainer
Stair Climber
Cycling
Aerobics
Jumping Rope
Other
I Don't Do
Cardio
* How many days
per week do you cardio?
-- Please Select --
1-2 Times/Week
3-4 Times/Week
5-6 Times/Week
Everyday
I Don't Do
Cardio
* How long is
each cardio session?
-- Please Select --
15 Minutes
30 Minutes
45 Minutes
1 Hour
Over 1 Hour
I Don't Do
Cardio
* What is your
cardio training intensity level?
-- Please Select --
Slow & Steady
Moderate
Intense
I Don't Do
Cardio
* What time of
day do you do your cardio training?
-- Please Select --
Morning
Afternoon
Evening
I Don't Do
Cardio
* What supplements
do you take before cardio?
* What supplements
do you take after cardio?
* Do you change
exercises between sessions?
-- Please Select --
Yes
No
* Do you keep
a journal of your cardio sessions?
-- Please Select --
Yes
No
* What type of
diet are you currently on?
-- Please Select --
Atkins
The Zone
South Beach
Jenny Craig
Weight Watchers
Vegetarian
Basic Low Calorie
Other Diet
I'm Not On
A Diet
* How many meals
do you eat per day?
-- Please Select --
1-2 Meals/Day
3-4 Meals/Day
5-6 Meals/Day
Over 6 Meals
* Do you eat breakfast?
-- Please Select --
Yes
No
Sometimes
* What size are
your average meals?
-- Please Select --
Small
Medium
Large
X-Large
* Do you tend
to snack during the day?
-- Please Select --
Yes
No
* What is your
most common cheat food?
-- Please Select --
Candy
Cake
Pie
Donuts
Ice Cream
Pizza
Hamburgers
Hot Dogs
Chips
Other
* How often do
you eat fast food?
-- Please Select --
Never
1-2 Times/Week
3-4 Times/Week
5-6 Times/Week
Everyday
* Do you tend
to binge when you cheat on your diet?
-- Please Select --
Yes
No
* Do you tend
to eat cheat foods late at night?
-- Please Select --
Yes
No
* Do you keep
a journal of your dietary intake?
-- Please Select --
Yes
No
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