Client Assessment - Men
Please fill out the form below.
This Client Assessment Form is a way for me to get to know you, your lifestyle and your specific goals as a client.
Please answer all questions as accurately as you can.


Before beginning your program, please visit your physician for standard blood work and a check-up in order to ensure that you have a clean bill of health.
This program is not intended to replace your physician’s recommendations and/or advice regarding decisions related to your health.

Email address *
1. Full Name *
Your answer
2. Email Address *
Your answer
3. Gender *
4. Age *
Your answer
5. Height *
Your answer
6. Weight *
Your answer
7. Average hours slept each night? *
Your answer
8. Rate your sleep quality *
9. Rate your daily stress levels *
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