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Transformation Program
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Training & Nutrition Assessment

General Information

Name

First Last

Phone

Email

Gender

Male

Female

Other

Age

Date of Birth

MM slash DD slash YYYY

Measurements

Weight (kg)

Height (cm)

Waist (cm)

Chest (cm)

Shoulders (cm)

Thigh (cm) - Left

Thigh (cm) - Right

Bicep (cm) - Left

Bicep (cm) - Right

Calf (cm) - Left

Calf (cm) - Right

Client Goals

Select your goals

Weight-loss

Muscle Gain

General Fitness

Muscular Strength

Aerobic Conditioning

Improved Flexibility

Other

How long after beginning your training do you expect to see results?

How would you describe your current activity level?

Sedentary

Moderately Active

Active

Highly Active

Questionnaire

How many times per week do you wish to train?

How much time per day can you allocate to training?

What kind of exercise do you enjoy?

Describe your training history

Have you had any injuries in the past? If so, please specify. If you undertake any additional therapies for the given injury please specify below.

Do you suffer from diabetes, asthma, high or low blood pressure? If so, please list below. Please specify if you have any other health conditions not mentioned.

Are you currently using chronic medication that may impact your training? If so, please specify.

Are you a current smoker?

Yes

No

Are you pregnant?

Yes

No

Diet Assesment

Your current diet is best characterized as:

Low Fat

Low Carb

High Protein

Vegan/Vegetarian

No Special Diet

Other

Blood Type

Please list any food allergies

How many times do you usually eat in a day?

Do you usually eat in the morning/ have breakfast?

List the foods you enjoy eating

How much water do you drink daily?

How long after starting your diet do you expect to see results?

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