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Gym Firebrand Online Training
To get started Training now, answer each question as honest as possible. I will collect data and this will help me create a custom Fitness plan for you. Once you send it, I will be in contact with you within 24hrs.
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Email
*
Your email
Basic Information
Name
*
Your answer
Height
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Your answer
Weight
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Your answer
Age
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Your answer
Do you consider your jobs and work as physically active? Describe it.
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Your answer
How long do you sit each day?
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1-2 hours for liesure
1-2 hours for work
3-4 hours after hours
The only time I don't sit, is when i'm walking to and from my car.
5+ hours a day
None of the above
How many hours per day do you spend sedentary, not moving?
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20-40 min
1-2 hours
3-4 hours
5-6hours
8+ hours
None of the Above
What are you sleep habits like?
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Your answer
Are there any other lifestyle habits you want me to be aware of?
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Your answer
Nutritional Planning
Details
On a scale of 1-5, please rate the amount of stress in your life from work.
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Less Stress
1
2
3
4
5
Very Stressed
On a scale of 1-5, please rate the amount of stress from family and social life.
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Less Stress
1
2
3
4
5
Very Stressed
On average, when do you go to bed and wake up?
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Your answer
Do you find yourself hungry before bed?
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Yes
No
Sometimes
Do you take vitamins or other nutritional supplements in the morning?
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Your answer
Do you eat protein within 20-30 minuets after waking up in the morning?
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Yes
No
Sometimes
Have you ever kept a food log?
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Your answer
Have you ever taken pictures of your food?
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Yes
No
Maybe
Do you know how to track calories?
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Yes
No
Maybe
Have you ever Yo-Yo dieted?
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Your answer
Health Notes
Brief health history
Do you suffer any pain?
Your answer
Are you sensitive to any foods?
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Your answer
Do you have frequent headaches?
Your answer
Are you currently pregnant?
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Yes
No
Maybe
Do you have high blood pressure? If yes, explain.
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Your answer
Do you have high Cholesterol? If yes, explain.
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Your answer
Have you ever had surgery? If yes, explain.
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Your answer
Do you experience fatigue ?
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Your answer
Have you ever been advised to avoid exercise by a physician? If yes, explain.
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Your answer
Does anyone in your family suffer from any cardiac conditions ? If yes, explain.
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Your answer
What are you allergic to? If yes, explain.
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Your answer
Are you currently taking medication? If yes, explain.
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Your answer
Any health issues that havent been discussed yet? If yes, please explain.
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Your answer
Have you ever tested your Basal Metabolic Rate?
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Yes
No
Maybe
Does a high carb snack or meal, with lots of veggies, bread, toast, cereals, rice, fruits, grains or potatoes as the main food source satisfy or stimulate your appetite??
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Yes
No
Maybe
Do you notice that you gain a lot of weight when you eat red meat, or lose weight? Do you look slimmer in the mirror or do your clothes fit easier?
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Yes I gain weight
No I lose weight
Maybe
Do you constantly look forward to the next meal, frequently thinking about foods and what you want to eat?
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Yes
No
What is your appetite like at breakfast?
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Hungry
Not hungry
Just coffee
Kind of hungry
What is your appetite like at Lunch?
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Hungry
Not hungry
Kind of hungry
What is your appetite like at Dinner?
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Hungry
Not hungry
Starving
Just a few bites
Do higher fat foods and/or higher protein foods such as dark meats, avocados, cream, butter, or coconuts within 1-2 hours of bedtime help you sleep better?
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Yes
No
I don't know
If you ate a large salad with some low-fat meat like chicken breast for lunch (versus a higher fat meat like a hamburger patty), how would it affect your productivity the rest of the afternoon?
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Energized
TIred
I don't know
How do you feel after you eat steak?
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Satisfied
TIred and hungry
I don't know
At Thanksgiving or a meal where you eat turkey, assuming all the turkey is moist, if you prefer white meat give yourself a 1, dark meat a 10, and no preference a 5
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1 White Meat
5 No preference
10 Dark meant
Required
Describe Breakfast
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Your answer
Describe Snacking habtis
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Your answer
Describe Lunch
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Your answer
Describe Dinner
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Your answer
Describe Dessert
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Your answer
Describe your pre training nutritional habits, if any.
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Your answer
Describe your post training nutritional habits, if any.
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Your answer
Describe all nutritional supplements you are currently using. Include multi-vitamins, sport supplements, electrolytes, and any special juices, pills, capsules or tablets
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Your answer
How much water do you drink a day?
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Your answer
What is your favorite food?
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Your answer
What food do you hate the most?
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Your answer
Optimally, how many meals woudl you prefer to eat per day?
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Your answer
What is your favorite guilty pleasure food?
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Your answer
What is your favorite protein food? , Beef, Chicken, Turkey, Fish, eggs, powder etc?
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Your answer
What is your favorite carbohydrate food sources do you like? Oats, potatoes, rice, bread, pasta etc?
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Your answer
What Fat source do you prefer? Olie Oil, Mcts, avocados, nuts, peanut butter?
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Your answer
What Fruits do you enjoy? Berries, bananas, grapes etc?
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Your answer
What green veggies do you enjoy? Broccoli, asparagus, edamame, kale, spinach, etc?
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Your answer
Do you ever have heartburn, gastrointestinal distress, or stomach problems? If yes, please explain
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Your answer
Please describe any religious, ethical, or logistical limitations regarding nutrition
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Your answer
Tell me about your goals, why you decided to do this, and why and how you're going to succeed?
*
Your answer
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