Client Questionnaire

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Please fill out the following questionnaire to help determine where you’re at in your fitness level and how Gina can best help you reach your goals. Please fill it out as best you can.

Personal Information
Your Name*
Your Email*
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Phone Number
Cell Phone Number
Age
Birthday
Date Format: MM slash DD slash YYYY
Gender
- Male
- Female
Height
Weight
Approximate Body Fat (%)
What service(s) are you interested in?
What are your Fitness Goals?
Lifestyle/Professional Activity Levels
How would you rate the activity level of your profession, or what do you do during the day (non-exercise related)?
What is one thing that motivates you to go after your goals?
Have you ever followed a specific workout program or diet plan? If so, please explain and be specific.
Current workout and cardio regimen (please be specific):
Have you ever had any injuries?
Are you currently on any medications? If so, please list them.
Current nutritional program, if any (please be specific)? If you are not currently following a program, please note.
Do you prefer variety in your diet or like to keep things simple, for convenience?
Do you like to cook and prepare homemade meals?
Please list a sample day's diet:
What are your favorite foods?
Any foods you dislike or are allergic to?
Competitors Only: Contest and Competition Info
If you have competed before, what are your previous shows and placing? Who have you worked with in the past, both trainer and nutritionist, if any?
Are there any upcoming contests you have in mind? Please list all you would be interested in.
If you have competed before, please explain in detail what your previous contest prep, both training and nutrition, consisted of. (Please be as detailed as possible)
If you are a previous competitor, what supplements do you usually or have you taken during your contest prep?
Phone
This field is for validation purposes and should be left unchanged.

Personal Information

Lifestyle/Professional Activity Levels

Competitors Only: Contest and Competition Info

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