| The following are questions that will help to form a Total Fitness Plan for you. Please fill them out as completely as possible and cut/paste them to best@mission1fitness.com or send them vial mail to the Mission 1 Fitness address on the "contact us" button. I offer a very affordable Total Fitness Plan with support to get you to where YOU want to be! What are you waiting for??? Get started, and I'll send you an E-mail when it's done and the ouchless price for it. Start being happy with your life instead of just surviving it! What do you have to lose? DIET: 1. How many times a day (as accurate as possible) do you eat? _____________________ ____________________________________________________________________________________________ 2. What are the usual times you eat? __________________________________________________ ____________________________________________________________________________________________ 3. List a sampling of a "normal" days meals. ___________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________. 4. What are your food " Likes "? _________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Food "Dislikes "? ______________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 5. Any metabolic diseases (Diabetes, thyroid... self or blood relatives)? ______________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 6. Any dental or gastrointestinal problems? ____Yes , ____No explain yes____________ ___________________________________________________________________________________________ 7. Any medications or supplements for either #5 of 6 above? ________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 8. What specific diets (eh 4 letter word) have you tried? _______________________________ ____________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 9. Any limitations for your diet or allergies in foods? ___No, Yes______________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Conditioning: 1. Any sports or activity Likes or Dislikes? _____________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 2. How many times a week & how long, do you do any of these activities, if any? ___________________________________________________________________________________________ ___________________________________________________________________________________________ 3. Do you smoke? ___No , ___yes, (what,how: much,long, often ...) ____________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 4. Any lung problems (sleep apnea, asthma, emphysema, shortness of breath, wheezing....? ____________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 5. Any vascular (blood vessel), or bone problems? ____________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ meds: ___________________________________________________________________________________ 6. Any history or cardio, aerobic, conditioning exercises in past? ____________________ __________________________________________________________________________________________ 7. Any limitations to exercise not already discussed? _________________________________ __________________________________________________________________________________________ 8. Ever use performance enhancing supplements (effedra, hormones, anabolic steroids) ? ___no, __yes...what? _______________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Muscle strengthening 1. Have you ever done any weight lifting? __no, ___yes..explain__________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 2. Ever used a Personal Trainer? ___no, ___Yes, details: ______________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 3. Any weight gain/loss within the past 3 years? ___No, ___yes, _______________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 4. Any: Muscle, skeletal(bone), or nerve problems? ___No, ___Yes, explain____________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Meds?______________________________________________________________________________________ 5. Any broken bones (fractures), chronic sprains, or surgeries? ___No, ___Yes, _______ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 6. Any limitations in range of motion, or anything else? __No, __Yes, ________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 7. Any supplements other than those already stated earlier? (Protein, glucosamine, creatine...) ___No, ___Yes, ______________________________________________________________ __________________________________________________________________________________________ ___________________________________________________________________________________________ 8. Any memberships in a Studio, Gym or have a home gym/weights? ___No, __Yes, what ___________________________________________________________________________________________ ___________________________________________________________________________________________ __________________________________________________________________________________________ Anything else you think I should know about you? Do you want me to be in touch with your Medical Provider, and stuff like that... ____________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________. |
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