Transform with jordfaye_fit
Client Questionnaire
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Age
Your Goal
Please Select
Loose Weight
Tone Up
Build Muscle
Please select from drop down box
What's your overall goal?
Current Form
Your current height and weight
Height
Feet - 5ft 6in
Weight
Lbs e.g 140lbs
File Upload
Browse Files
Drag and drop files here
Choose a file
Please upload 3 pictures in underwear (front, back and side) - best in a morning before you’ve eaten
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of
Measurements
Centimetres
Chest
Waist
Hip
Left thigh
Left arm
Health
Your current lifestyle habits
On average how many hours sleep do you get a night?
Do you have trouble sleeping at night?
Do you feel as though you get good quality sleep?
Do you have any injuries that I need to be aware of?
Do you have a regular period?
Please Select
Yes
No
Date of last cycle
Do you notice any change in strength, hunger, performance during your cycle?
If yes please let me know what changes you have noticed
Lifestyle
What is your occupation?
What hours do you work?
Activity level
Please Select
Sedentary
Lightly active
Moderately active
Very active
Nutrition and Supplementation
Do you have experience tracking calories and macros?
Please Select
Yes
No
On average how many calories do you consume a day?
Please provide a 3 day food diary
How many litres of water do you drink a day?
How many times do you drink alcohol a week?
How many drinks do you consume at one time?
Do you take vitamins or supplements?
Please Select
Yes
No
If so please specify
Workouts
How many steps do you do a day?
How much cardio do you do a day?
How many times a week can you commit to working out?
Favourite exercises you want to see on your plan
Exercises you struggle with and don't want to see on your plan
How experienced are you with weight training?
Please Select
Beginner (no experience, not confident in the gym)
Intermediate (less than 12 months, feel okay in the gym)
Advanced (over a year, feel confident in the gym)
Where do you want to workout?
Please Select
Gym
Home
If you selected home workouts please list equipment you have available
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