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Personal Profile Information (required) |
Name
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Address
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City
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Zip Code
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E-mail
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Date of Birth: |
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Height |
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Weight |
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Body Fat %: |
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| How did you hear about us? |
MFS Coach
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| Please choose which special you are interested in: (hold down the control key to select multiple entries) |
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What is your desire?
(hold down the control key to select multiple entries)
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What services do you want a trainer to provide? (hold down the control key to select multiple entries) |
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How often would you like to meet with your trainer?
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Where would you like to train?
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When would you like to begin training?
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Do you prefer a male or female trainer?
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Additional Details: |
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Which best describes you? |
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Health and Medical Conditions |
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Daily Life Questions |
| What time do you normally wake up? |
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| What time do you normally go to bed at night? |
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| If you smoke, how many years have you smoked? How much? |
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| If you drink alcoholic beverages, what type and how many per day? |
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| Are you allergic to any foods? If so, what are they? |
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| Have you ever been placed on a nutritional program in the past? |
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| What were your results? |
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Weekly Exercise Information |
| Explain in detail what type of resistance exercises, cardiovascular or sports activities you perform on average during a 7-day period. Please also provide the frequency and duration of these activities. |
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| How would you rate the activity level of your profession, or what you do during the day (non-exercise related). |
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Food Record |
| Please describe what you eat on a daily average. Include portion sizes (e.g., small, medium, large) any drinks or snacks and vitamins or supplements. Provide as much detail as you like. |
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| Make a list of your favorite foods: |
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| Make a list of foods you dislike: |
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Finished |
| Press the Submit button to forward your profile information to one of our consultants. |
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