Name
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First Name
Last Name
Email
*
Phone
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(###)
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date of Birth
*
MM
DD
YYYY
Age
Height
*
Weight (please weight yourself first thing in the morning on an empty stomach)
*
Goal Weight (if you have one)
Shirt size
Instagram Handle
Facebook username
How did you hear about Team Flawless Physique?
Job Description
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What do you do? How many hours do you work? How active are you through out the day?
Hours of work
How active are you at work and throughout your day?
Are you able to pack your meals and eat them at work?
*
Are you married or in a committed relationship?
Do you have children?
Short Term Health/Fitness Goals
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What are you hoping to achieve in the next 3 months?
Long Term Health/Fitness Goals
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What are you hoping to achieve in the next 1-2 years?
Do you have any diagnosed health conditions?
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Are you experiencing any symptoms we need to address?
How many hours of sleep do you get on average per night?
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How much water on average do you drink per day?
*
When was your last menstrual cycle? (if applicable)
Are you taking any medications?
If yes, please list medications and dosages.
What supplements are you currently taking (vitamins, pre workouts, etc)?
*
Please list names and dosages.
What is the biggest issue that has held you back from your goals?
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What is your current diet? What does a typical day of eating look like for you?
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If you are not currently following a nutrition plan, please write out in detail what you have eaten in the past 2 days.
Are you familiar with tracking macros using MyFitnessPal (or any other app)? If so, what are your current macros?
With your current diet and exercise routine, have you been losing, gaining, or maintaining weight?
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Do you have any food allergies or food sensitivities?
What are a few foods (if any) that you refuse to eat?
What are a few of your favorite foods that you enjoy eating?
Do you have any other dietary restrictions?
What day of the week is best for you to meal prep?
How much cardio are you currently doing per week?
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Please describe the duration, frequency, and intensity of your current routine.
What cardio modalities do you have access to? (Treadmill, Stairmaster, Elliptical, Rower, Bike, etc.)
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Please list anything other details of your cardio routine you feel are important.
Rate your experience level with resistance training (beginner, intermediate, or advanced):
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How many days per week are you currently exercising? For how long?
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How many days per week are you willing and able to exercise?
*
What is your current exercise routine?
Please be as detailed as possible.
Do you have any current or past injuries?
*
What time of the day do you normally train?
What would be your preferred REST or OFF Day?
Choose your Coach
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No preference, you can choose the best fit for me
Steve Mousharbash
Alexis Davis
Fallon Wainwright
Ryan Wainwright
Jamie McCarthy
Time Commitment
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Monthly
3 Months
6 Months
Date you would like to start
MM
DD
YYYY
