Training and Diet Questionnaire

Name

Email

Address

Street Address City ZIP / Postal Code

Training

What is your current training regimen? (Please include lifting schedule, rest times, rep range, number of sets, cardio schedule, cardio intensity and duration)

How long have you been following your current training regimen?

When did you begin structured workouts? (going to the gym with specific workouts)

Have there been any periods of inactivity since beginning to exercise? Please explain

Were you active in sports as a child and/or teen?

Would you say that you were a thin/average/overweight child and teen?

At any point in your life, have you suffered from an eating disorder or simply been depressed due to your weight?

Have you ever worked with a trainer? Please explain your experience

What is your specific goal? (Pounds lost, inches lost, pant size to fit, etc.)

What challenges do you face in your life that influences your ability to follow a training plan?

Nutrition

What is your current eating plan? How long have you been eating like this?

What eating plans/diets have you tried in the past that worked for you?

When did you try this?

What was your training like at this time?

What eating plans/diets have you tried in the past that did NOT work for you?

When did you try this?

What was your training like at this time?

Name food allergies and healthy foods that repulse you

What is your current age/height/weight/bodyfat % (if you know)

Were you an active child and/or teen?

When did you begin paying attention to what you ate to lose weight or maintain your weight?

What are your weaknesses in regards to food?

What challenges do you face in your life that influences your ability to follow a structured eating plan? (health condition, work schedule, family activities, kids’ eating habits, etc.)

Phone

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ADDRESS Sacramento, California,