Which coach did you sign up to work wIth?*Steven MitropoulosRachel TomapatDate* Date Format: MM slash DD slash YYYY Full Name* First Last Email* Your Age*Please enter a number from 16 to 100.Phone*1) Are you currently dieting?*YESNO2) Current weight*Please enter a number from 75 to 600.3) Height*4) Current goal(s)*5) What does your current diet look like? PLEASE BE SPECIFIC*6) What time do you prefer to train?*7) How many meals do you eat currently?*8) What meal number will be your pre-workout meal?*9) Are you employed?*YESNO10) Describe your daily schedule:*11) Are you able to do morning fasted cardio separate from scheduled work out?*YESNO12) Any specific days you need to have off from the gym and/or cardio?*13) How many days would you prefer to workout per week?*4 Days5 DaysThink about sustainability and what you would be able to consistently be able to commit to each week.14) Any allergies to food or medication? If so, please list.*15) Any current injuries I should be aware of? Any previous injuries or surgeries?*16) Are there any foods you dislike, or won't eat?*17) Are there any foods you would love to see included in your daily nutrition that would help you be more consistent in following your plan?*Be realistic here --- examples: pasta, English muffins, cereal, bagel, wraps etc.18) Are there any obstacles you’re facing that may impede your success?****** By completing this questionnaire you acknowledge that you are required to give 14 days’ notice prior to cancelling services otherwise you will be required to pay per normal based on pricing agreement for the current month. ALL PLANS ARE REQUIRED TO A 3 MONTH COMMITMENT (payment for 3 months NOT due up front, only the first months payment is)Add your name again below, as your signature and acceptance of this agreement* First Last Please Upload FRONT/BACK and SIDE photos of yourself so we can get started. Drop files here or Accepted file types: jpg, gif, jpeg, png. Δ
