Name * First Name Last Name Email * What are your health/ fitness goals? * What are your past attempts, and how did they go? Do you exercise regularly? If so, what does your current fitness routine look like? * Do you or have you ever suffered from high blood pressure? * Yes No Do you or have you ever suffered from heart palpitations? * Yes No Do you or have you ever suffered from fainting or lightheadedness? * Yes No Do you have a family medical history of heart disease? * Yes No Do you have any other health conditions that might impact programming, training or your ability to comply? * Yes No If so please explain below What are sources of stress for you, and what do you do to recover from that stress? Do you have kids? Yes No Do you have a partner? Yes No If yes, is that a supportive relationship? Yes No Does your job introduce potential barriers to healthy eating? * Yes No How often do you go out to eat? 0-1 time per week 2-4 times per week 5+ times per week How often do you drink alcohol? * I don't drink 1-2 days per week 3+ days per week How often do you use recreational cannabis? Never 1-2 days per week 3+ days per week List any medications you are currently taking * List any vitamins/supplements you are currently taking How is your sleep? Anything else that you think I should know about you Thank you! This data will help me create a custom experience for you!
