Subjective Information Assessment

Name:

Email:

Phone:

1. What is your goal?

2. Are you willing to complete the exercises I assign you during the week on your own?

3. Have you ever broken or sprained anything? If so, explain.

4. Typically, how many meals do you eat per day? And, what time do you eat them?

5. Approximately how many calories do you consume per day?

6. Do you know how many calories you should be consuming daily to reach or support your goal? If so, how was that determined?

7. Are you currently taking any multivitamins or other dietary supplements? If so, what are you taking? If not, why?

8. How would you describe your diet? Regular, vegetarian, vegan, lacto-ovo, other?

9. Typically, how many meals do you eat outside your home per week? Would the majority of these meals be described as fast food or sit-down restaurant?

10. What is your favorite cuisine? American, Tex Mex, Italian, Chinese, etc.?

11. Do you smoke? If so, how many a day.

12. Do you drink caffeine? (coffee, tea, sodas, etc.) If so, what do you drink and how much?

13. Do you drink alcohol? If so, how many drinks per week?

14. Have you ever worked with a trainer? If so, describe the experience. If not, what are your expectations?

15. Are you currently tracking how many steps you are taking per day? If not, are you willing to track your steps?

16. Are you willing to keep a food log and track your calories?

17. Are you committed to keeping our training sessions except for illness or emergencies?

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