New Client Questionnaire

Name

First Name

Last Name

Email Address

Phone

(###)

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Age

Height

Weight

Body Fat Percentage

If you don't know, leave blank

Goals

Check all that apply

Lose Weight

Increase Lean Muscle

Tighten up Nutrition

Prep for Fitness Competition

Prep for Sporting Event or Athletic Activity

How often do you exercise? What type of physical activities do you enjoy?

Do you have any medical concerns, including injuries, previous surgeries, or are you being treated for a chronic condition that requires medication?

How would you describe your current diet? Do you have a good nutrient balance of carbohydrates, protein and fat in your daily diet?

Do you have any food allergies? What are your favorite foods and which foods do you avoid?

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

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First-Time Clients... Please complete the following