Thank you for your purchase. Kindly fill out this questionnaire below to proceed to the next step. Full Name Email Weight/Height Date Of Birth(DD/MM/YY) Personal or Family History of Heart Disease History of Diabetes History of Hypo or Hyperthyroidism Joint or Back Problems History of Surgeries or Injuries Affecting Exercise Ability Current Medications Prescription Non-Prescription Dietary Restrictions or Preferences (e.g., Vegetarian, Vegan, Gluten-Free) Rate Your Current Nutrition Habits on a Scale of 1-10 Current Fitness Level Beginner Intermediate Advanced Primary Fitness Goals (Weight Loss, Muscle Gain, Improved Endurance, etc.) Access to Gym or Preference for Home Workouts Preferred Communication Method with Coach RJ Email Text Message Frequency of Communication Preference (e.g., Weekly Check-Ins, As Needed) How many days per week would you like your program built for? Please select from the following options: 2 days per week 3 days per week 4 days per week 5 days per week 6 days per week Typical Daily Diet Breakfast Lunch Dinner Snacks Beverages Food Allergies or Intolerances Favorite Food Foods You Dislike or Avoid Frequency of Eating Out or Ordering Takeout (per week) Cooking Skills Select Beginner Intermediate Advanced) Do you track your food intake? If yes, what method or app do you use? Do you take any dietary supplements? If yes, please list them: Any specific dietary goals (e.g., increase protein intake, reduce sugar, etc.) Describe any past experiences with dieting or nutritional programs Current Medications Select Prescription Non-Prescription, Dietary Supplements Any additional information about your diet or nutrition that would be helpful for Coach RJ to know Submit Answers
