You have just taken the first step toward achieving your personal fitness goals. The next step is to complete this health, fitness and diet questionnaire as accurately as possible. When finished press submit. Thank-you!
Questionnaire
EXERCISE INFORMATION
Do you have access to any of the following:
(Check all that aply:)
Gym or Fitness Center
Aerobic classes or video tape
Treadmill Stationary Bike
Swimming pool
Walking or Biking trail
Weight lifting equipment
Other (explain):
NUTRITION INFORMATION
Are you allergic to any foods? Yes
No
If yes, explain:
What foods do you absolutely hate, and will not eat?
What are your favorite foods?
Do you drink coffee or tea? Yes
No
How many soft drinks do you drink per week?
How many servings of fruit juice do you drink per week?
Do you drink alcoholic beverages, and if so, what type and how many per week?
Check below all that are acceptable in your meal plan:
Meat
Poultry
Eggs
Seafood
Dairy products
