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About
Basic Info
Tell us a little about yourself.
Name
How is your name pronounced?
Today's Date
Month
Select month
1
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Day
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Year
Select Year
2122
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E-mail
Birthdate
Month
Day
Year
Sex
XY
XX
Height
in/cm - please label
What are your main goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Increased power
Fat loss
Weight gain
Sport specific
Weight
kg/lbs - please label
Do you have a specific timeline for achieving a specific goal?
Yes
No
What's more important to you?
Immediate progress that's less-easily maintained
Maintainable progress that may not be as rapid
Exercise Information
Rate your ability in the following exercises:
Barbell squats
Advanced
Intermediate
Novice
Beginner
Barbell deadlift
Advanced
Intermediate
Novice
Beginner
Barbell bench press
Advanced
Intermediate
Novice
Beginner
Bent-over barbell row
Advanced
Intermediate
Novice
Beginner
Barbell shoulder press
Advanced
Intermediate
Novice
Beginner
Pull-up
Advanced
Intermediate
Novice
Beginner
Barbell snatch
Advanced
Intermediate
Novice
Beginner
Barbell clean
Advanced
Intermediate
Novice
Beginner
Are you currently exercising regularly?
Yes
No
Lifestyle Information
Please tell us a little more about your day outside of the gym.
What do you do for a living?
What is the activity level at your job?
None
Low
Moderate
High
Do you travel for work?
Yes
No
Please list any activities that you participate in outside of the gym:
If you have any diagnosed health problems, please list them:
If you are on any medications, please list them:
What additional therapies or interventions are being undertaken for the given health problem(s)?
If you have any injuries, please list them:
What additional therapies or interventions are being undertaken for the given injury/injuries?
Submit
