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Client Profile Questionnaire

General Health & Nutrition Questions

Personal Profile Information

Gender
Male
Female
Birthday
Month
Day
Year

Weekly Exercise Information:

Explain in detail what type of resistance exercises, cardiovascular or sports activities you perform in average an average week.

Lifestyle / Professional Activity:

How would you rate the activity level of your profession, or what you do during the day (non-exercise related).

Activity Level
Sedentary
Moderately Active
Active
Very Active

What are your goals:

Goals (Choose all that apply):

Protein Requirements:

Protein Needs (Which best describes you)

Body type:

Select an option (which best describe you)
I can eat practically anything I want and I do not gain weight. I find it hard to gain weight.
I can lose or gain weight by adjusting my activity level and eating habits
I find it difficult to lose weight. I can gain weight by just looking at food and have to watch what I eat.

Health and Medical Conditions:

Health Condition/s (Select all that apply or describer any others)

Preferred Food Selection:

Select the foods you enjoy:

Protein Selection
Carb Selections:
Fat Selections:

Lifestyle Questions:

Time you wake up
Time
HoursMinutes
Time you go to sleep
Time
HoursMinutes
Time you will workout
Time
HoursMinutes

WAIVER: 

I agree to allow Enlightened Athletics to design a fitness and/or nutrition program for me to enhance my health and fitness goals. I will follow that program to the best of my ability and I will not hold Enlightened Athletics or their owners, employee or agents personally liable for any problems, illnesses or injuries that might occur due to a sudden change in my training or eating habits. I understand that the coaches at Enlightened Athletics are not registered or licensed dietitians, nor are they medical practitioners. This training and/or nutrition program  does not replace the expert advice or medical treatment of my own private doctor. I have provided Enlightened Athletics all necessary information about myself to prevent any possible complications. 

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OPENING HOURS

Appointment Only

ADDRESS

610 E 55th Ave #450

Denver, CO 80216

Tel: 303-345-7998
Email: ryanwhite@eathletics.fit

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