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• *** Copy/Paste everything below this line into the box below. Record your answer next to each question. ***

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  Basic Info & Stats 

   

  • Full Name:

  • Age:

  • Height:

  • Current Weight:

  • Waist circumference (at belly button):

  • Estimated body fat % (if known: InBody, DEXA, calipers, etc.):

  • Body type (Ectomorph, Mesomorph, Endomorph, Unsure):

  • Do you have recent labs or do you plan to get labs soon?:

   

   

  Health & Medical 

   

  • Current or past injuries that may limit training:

  • Current medical conditions (hypertension, diabetes, thyroid, etc.):

  • Current medications:

  • Current supplements:

  • Allergies (food, medication, environmental):

  • Past surgeries (if relevant):

  • Family history of major medical conditions (heart disease, diabetes, cancer, etc.):

   

   

  Lifestyle & Recovery 

   

  • Occupation & typical work schedule (include travel, shift work, long hours, etc.):

  • Average nightly sleep (hours):

  • Average daily steps (if tracked):

  • Stress level (low, moderate, high):

  • Do you struggle with anxiety, depression, or other mental health concerns? (Yes/No — optional details):

  • Alcohol use (type, frequency, amount):

  • Nicotine use (Yes/No):

  • Recreational drug use (Yes/No, optional details):

   

   

  Training & Activity 

   

  • Current exercise routine (if any):

  • Preferred types of exercise (weights, cardio, swimming, sports, etc.):

  • Exercises you dislike or want to avoid:

  • Exercise restrictions from a doctor? (Yes/No, explain):

  • Equipment access (gym, home gym, Tonal, resistance bands, treadmill, bike, pool, none):

  • How many days per week can you realistically train?:

  • How much time per workout can you dedicate (minutes)?:

   

   

  Nutrition

  • Do you follow any specific diet? (Keto, Paleo, Mediterranean, etc.):

  • Dietary restrictions (vegetarian, gluten-free, dairy-free, etc.):

  • Food preferences (e.g., hate fish, love red meat):

  • Do you currently track calories/macros? (Yes/No, if yes provide average intake):

  • Approximate daily water intake:

  • Approximate daily caffeine intake (coffee, energy drinks, etc.):

   

   

  Background & Circumstances 

   

  • Fitness history (sports, training, dieting experience):

  • Current life circumstances that may affect adherence (work travel, family, stressors):

  • Do you have support from spouse/partner/family for making lifestyle changes? (Yes/No):

   

   

  Other

  • Anything else I should know to create the most accurate blueprint possible: