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Nutrition / Cardio / Training Questionnaire
Please complete the following questionnaire to begin your journey to looking good and feeling great.
First Name:
Last Name:
Email:
Address:
City, State, Zip:
Phone Number:
Birth Date (dd/mm/yy):
Height:
Current Weight:
Have you worked with a trainer or coach before? If so, when and who?:
Diets you have tried:
Medications you are taking:
List any allergies:
List any injuries you have:
What kind of cardio are you doing and how many days a week?:
What kind of training are you doing and how many days a week?:
What time(s) of the day do you do your training and cardio?:
What time do you get up and what time do you go to bed?:
What are your long term goals?:
Provide a three day journal of your food intake:
How did you hear about me?:
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