Please Complete All of the Questions.

1
Your Name* This field is required
First Name
Last Name
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2
Gender* This field is required
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3
Your E-mail* This field is required
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4
Your Date of Birth:* This field is requiredMM/DD/YYYY
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5
What Are Your Goals?* This field is requiredYou may Select More Than One
Fat Loss
Muscle Gain
Improve Overall Health
Live A Healthier Lifestyle
Train For An Event or Sport
Learn More About My Body
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6
How Often Do You Weigh Yourself?* This field is required
Never
Once a week
Two or Three Times a week
Every Day
Multiple times per day
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7
Do You Have Any Medical Conditions* This field is required
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8
If You Answered YES to Having Medical Conditions, Please Answer The Following:
Please List Any Known Condition.
Please List Any Prescriptions You Are Taking For These Conditions.
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9
What Diet or Lifestyle Methods Have You Tried?* This field is requiredPast & Current Methods Please
Paleo
Keto
Low Carb
Gluten Free
Vegan
Carnivore Diet
Atkins
None
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10
If you selected OTHER, please tell us about the plan and how it worked for you:
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Ok
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11
What Foods Do You Prefer?* This field is requiredCheck All That Apply
Chicken and Turkey
Fish & Seafood
Beef & Pork
Beans, Legumes, Sprouts
Vegetables
Fruit
Dairy Milk, Yogurt , Cheese, Eggs
Non-Dairy Milk, Cheese, Yogurt
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12
Are You Currently Tracking Your Calories?* This field is required
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13
If YES, please list the app(s) you are currently using:
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Ok
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14
How Many MEALS and SNACKS Do You Consume Per Day?* This field is required
How Many Meals?
How Many Snacks?
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15
Do You Eat All Of Your Calories In One Meal?* This field is requiredExample: You eat once a day at 12 P.M.
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16
How Many of those Meals or Snacks are from Fast Food/Convenience Stores, Frozen, or "Heat & Eat"?
How Many Meals?
Tell us Where It Comes From (Ex: Fast Food, Frozen etc)
How Many Snacks?
Tell us Where It Comes From (Ex: Fast Food, Frozen etc)
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17
Do You Eat Breakfast?* This field is required
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18
Do You Follow An Intermittent Fasting Schedule?Example: Last meal by 7pm on Monday and your first meal is 11am on Tuesday
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19
If you follow an Intermittent Fasting Schedule, How Many Days Per Week And How Long Do You Fast?
How Many Days?
How Long?
If "OTHER", please explain.
Do You Perform Exercise In A Fasted State? (No food)
If YES, What Type Of Exercise Do You Do Fasted?
If "OTHER" exercise, please explain.
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20
What Time Do You Usually Eat Dinner?* This field is requiredEx: 7pm on Weekdays and 9pm on Weekends.
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21
Do You Snack After Dinner?
Do You Snack After Dinner?
How Often?
What Kind Of Snacks Do You Go For?
If "OTHER", please explain.
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22
Do You Experience Food Cravings?
Do You Get Cravings?
How Often?
What Do You Crave?
If "OTHER", please explain.
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23
Do You Drink Coffee?
Do You Drink Coffee?
How Many Cups Per Day?
Do You Add Anything to your coffee?
If "OTHER", please explain.
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24
Do You Consume Energy Drinks?
Do You Consume Alcohol?
How Many Drinks:
What Brand?
If "OTHER", please explain.
Why Do You Use Energy Drinks?
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25
Do You Consume Alcohol?
Do You Consume Alcohol?
How Many Drinks Per Week?
What Type?
If "OTHER", please explain.
Do you use alcohol to cope with stress?
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26
Do You Smoke?* This field is required
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27
If you do smoke, please tell us how many per day and frequency.Ex: 1 pack of cigarettes every 3 days
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28
Do You Struggle With Making Healthy Choices or Preparing Meals?
What Do You Struggle With?
How Many Per Day?
What Brand?
If "OTHER", please explain.
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29
Do You Have Any Past or Current Injuries?* This field is required
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30
If You Answered YES to Having Injuries, Please Answer The Following:
Please List Any Known Injury and Body Part(s) Affected
Please List Any Prescriptions You Are Taking Or Treatments Done For These Conditions.
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31
Do You Exercise Currently?* This field is required
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32
How Many Days Per Week Do You Exercise?* This field is required
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33
What time of day do you usually exercise?
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34
If you exercise, please select what activities you do:
Strength Training
Cardio Training
Strength & Cardio Training
Pilates/Yoga
Power Walking
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35
I Do Best With...* This field is requiredYou may Select More Than One
Having a personal trainer
Participating in Group Fitness
Working out at home
Following a written program
Doing my own thing
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36
Do You Struggle With Finding The Time or Motivation To Exercise?* This field is required
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37
Do You Work?* This field is required
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38
If you have a job, please select all that apply:
I work outside my home.
I work inside my home.
I work out of town.
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39
What Shift Do You Normally Work?
Day Shift (9am-5PM)
Day Shift 12 Hrs (7am-7pm)
Afternoon Shift (3pm-11pm)
Night Shift (7pm-7am)
It Varies
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40
Do You Get a Designated Lunch Break?
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41
Do You Enjoy Your Job?
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42
Please Indicate The Stress Level of Your Job Using The Slider:
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43
What Time Do You Normally Go To Bed?* This field is required
8-9 P.M.
10-11 P.M.
Midnight or later
It Varies
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44
Do You Wake Up Multiple Times During The Night?* This field is required
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45
If you do wake up, are you able to get back to sleep?
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46
Do You Feel Rested When You Wake Up?* This field is required
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47
Do You Sleep with TV Screens or other bright lights on in your room?* This field is required
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Should be Empty: