Wellness Evaluation Please enable JavaScript in your browser to complete this form.Current Weight?Goal Weight?Height?Age?How many times per week do you eat takeout? What are your fitness goals? Choose more than one option (Build muscle, Tone/maintain, Lose weight, gain weight, lose fat, increase stamina, increase athleticism, build back, build lower body, build chest/arms, other (please specify)What do you normally eat throughout the day? Be specific.Do you have energy loss during the day?What time do you have breakfast?What time do you typically have lunch?What time do you eat dinner?How many cups of coffee / tea do you have per day?How much sugar do you add to each cup?How much water do you drink?Do you smoke and how much?Do you suffer from headaches?Do you suffer from constipation?How much alcohol do you drink in a week? please specifyHow many chocolates, chips & sweets do you eat per week?How many cold drinks do you drink per week?Which other program have you tried and why did it not work?Do you have health problems, injuries or concerns? Please specifyHow many times do you exercise per week?Please also give a summary of the workouts you have been doing, including duration and sets and also please list all equipment you may have or use at the gym or from home workouts.Submit
