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Women's Health and Fitness Specialist

Fill out the form below and let's put together a personalized plan to successfully achieve your health and fitness goals.

Medical Questionnaire

Please fill out the following form to help us understand your medical/physical condition.

general

Gender
What tim zone are you in?

lifestyle

Daily Average Activity Level?
How many hours of sleep do you average per nite?
Are you overweight?

Health and Nutrition

Do you currently suffer from any of the following conditions? Check ALL that apply: Obligatorio
Do you have Food Allergies? Obligatorio
Are you currently taking any medications or supplements
Dietary Preference Obligatorio
What Style Nutrition Guide would you like prepared? Obligatorio

fitness history & goals

Weekly Average Workout Regime (Home or Gym)? Obligatorio
Average session time? Obligatorio
What is your main Fitness Focus? Obligatorio
Is there a specifec body region you'd like highlighed in your Fitness Regime? Obligatorio
What type of Fitness Regime do you want setup (Where will you be working out)? Obligatorio
What kind of bench do you have? Obligatorio
Do you have any injuries that need to be taken into consideration for your fitness program?
Do you have any specific health conditions that need to be taken into consideration for your customized Nutrition and/or Fitness program?
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