Screening Questionnaire Name * First Name Last Name Email * Phone * Country (###) ### #### Please provide your age, weight, gender, and height What is your fitness goal? * What is your occupation and schedule? (list out your day by hours) * How many years have you been training? * Beginner (<1 year) Intermediate (1-3 years) Advanced (3-5+ years) What is your current diet? * How many days can you train weekly? * 1 2 3 4 5 6 7 Do you have any pre-existing heart conditions, take blood pressure medication, or experience chest pain or dizziness during exercise? * Yes No Do you have a medical condition? Please explain and list any medications. * Do you use any exogenous hormones? * Yes No Please list if so What level of training are you looking for? Level 1: Semi-custom training program, tailored dietary advice, and a follow up video call with me Level 2: Custom diet plan Level 3: 1 on 1 online coaching List any supplements or vitamins you currently take Thank you!