Start-up Questionnaire Start Up Questionnaire Start-up QuestionnaireName *Email Address *Phone *Home Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryDate of birth Height Weight Starting Date *Contest/Event Date Contest Name or Event Name Please take your time to complete the following questions to the best of your ability. It is vital that you be as open and honest with us, knowing that all information gathered is strictly confidential.How can we help you? Describe your short term and long term goals. Please list any medical conditions and/or injuries that you have. Please list any medications and/or supplements you currently take. Have you had coaching in the past? If so, please explain duration, type, etc. Are you inquiring for nutrition, training, or a combination of the both? NutritionDo you know how many calories/macros you consume on average daily? If so, please describe. Protein-Carbohydrates-Fats (please provide as much information as possible) Include foods you love vs. dislike. Attach current nutritional intake if available List out your meals (we want to see what your current eating habits are) Breakfast (time of day and what you consume Lunch (time of day and what you consume) Dinner (time of day and what you consume) Snacks (time of day and what you consume)Do you have any food allergies? If so, please list. How would you describe your current relationship with food? Have you ever been treated for an eating disorder, or have you experienced eating disorder symptoms in the past or present? Have you had customized nutrition planning in the past? If so, please describe. How much cardio do you perform each week and what type? (ie. HIIT, circuits, classes, running, include length of time etc). Describe your current training regime (days per week, split, focus, feel free to attach your current program for simplicity). Please describe your fitness history Do you have any limitations to performance? If so, please describe. What is your preferred style of exercise? Ex. Classes, crossfit, weight training, plyos, track work etc.How comfortable are you with basic weight room terminology? What gym do you train out of? or Please list the equipment available to you (ie. Treadmill, DB’s, power racks, elliptical, etc.) What exercises do you feel most comfortable with? Please list any other questions, concerns or information about yourself that will help us develop the best programming for you Must Upload Current Photo Must Upload Current Photo Must Upload Current Photo Must Upload Current Photo VerificationPlease enter any two digitsExample: 12This box is for spam protection - please leave it blank:
