Health Quiz

Welcome to the family!

Thanks for signing up!

Please fill out the health quiz below so that we can get started on your program as soon as possible. Please give us 3-5 business days to work on it. Good things take time!

Note: If a question doesn’t apply to your plan, please enter “N/A” or feel free to leave the answer space in blank.

Name

First Name

Last Name

Email (please use the same one you signed up with)

Phone number (with area code)

Gender

Date of Birth

Height

Current weight (please specify if lbs or kg)

Is your current weight different from 6 months ago? If so, please describe.

Do you know your current body fat percentage?

What are the goals you would like to achieve with us?

Do you suffer from any type of heart problems, cardiovascular or chronic disease? If so, please describe.

Do you take any new medications? If so, please specify.

Do you have any food allergies or intolerances?

Are there any foods you dislike?

What is your current meal schedule?

Do you follow a particular type of diet? If so, please describe.

Examples include: Regular diet, Vegan, Vegetarian, Intermittent Fasting, Keto, etc.

How would you describe your appetite?

How many cups or liters of water to you drink per day?

Do you take any dietary supplements? if so, please list them.

Have you had any of the following surgeries: Gastric Sleeve, Bypass, Mommy Makeover, Tummy Tuck or any other physical surgery? If so, please describe and when was your surgery?

How many days per week are you able to workout?

Please describe your current workout split and/or type of workout:

Where do you work out from? (So that we can have a clear idea of what equipment would be to your disposal)

Home

Regular Gym

Small Local Gym

If working out from home, what equipment do you currently have?

Do you have any current injuries? If so, please explain.

Are there any additional comments you would like to share with us?

How did you hear about us?

Friend, Doctor, Instagram, Facebook, Other

Note: If using our App, please enter your monthly biometrics: weight, body fat percentage and measurements. Just head to your main dashboard, click on “Body Weight” and enter your current numbers. This is recommended to do every month before updating your plan.

Additional instructions on how to take and interpret this information can be seen in our Body Composition Guidelines. To download the guidelines please click here.

Schedule your first monthly consultation.

Let’s talk about your goals (included in your plan).

Please choose a date and time in our calendar to schedule your call.