YOURPROFILE

GENDER *MALEFEMALE

HEIGHT *

WEIGHT *

CHEST GIRTH *

WAIST *

HIPS *

WHAT IS YOUR TYPE OF BODY?ECTOMORPHMESOMORPHENDOMORPH

ON SCALE OF 1 – 10, HOW WOULD YOU RATE YOUR PRESENT FITNESS LEVEL (WHERE 1 IS VERY BAD, AND 10 – EXCELLENT) *12345678910

ARE YOU HAPPY WITH YOUR BODY COMPOSITION / PHYSICAL SHAPE NOW?NOYES

WHEN HAVE YOU THOUGHT TO IMPROVE YOUR BODY SHAPE FOR THE FIRST TIME?LESS THAN 6 MONTH AGOMORE THAN 6 MONTH AGOMORE THAN 1 YEAR AGO

CREATING THE FM PROGRAM WITH *

HOMEGYM ACCENT

ARE YOU ENERGETIC? *NOYES

DO YOU PRACTICE ANY KIND OF SPORTS REGULARLY?NOYES

DO YOU PARTICIPATE IN SPORTS COMPETITIONS? *NOYES

SELECT YOUR PHYSICAL ACTIVITY AT WORKLOWMEDIUMHIGH

MARK YOUR DESIRABLE WORKOUT DAYS, IF REQUIRED

MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAYSUNDAY

PLEASE RATE YOUR SURROUNDING STRESS LEVEL AT WORK *LOWMEDIUMHIGHVERY HIGH

PLEASE RATE YOUR SURROUNDING STRESS LEVEL AT HOME *LOWMEDIUMHIGHVERY HIGH

DO YOU WORK OVER 40 HOURS WEEKLY? *NOYES

SELECT YOUR SLEEP TIME DURATION? *LESS THAN 6 HOURS6–7 HOURSMORE THAN 7 HOURS

DO YOU CONSIDER YOUR NUTRITION HABITS AS HEALTHY? *NOYES

DO YOU HAVE BREAKFAST REGULARLY?NOYES

HOW MANY TIMES DO YOU EAT PER DAY (INCLUDING SNACKS) *1-3 TIMES4-6 TIMESMORE THAN 6 TIMES

DO YOU SKIP MEALS? *NOYES

DO YOU EAT IN LESS THAN 2 HOURS BEFORE BEDTIME? *SOMETIMESOFTENNEVER

DO YOU FOLLOW A PARTICULAR DIET AT THE MOMENT? *NOYES

HOW MANY CUPS OF COFFEE DO YOU DRINK PER DAY? *1-2 CUPS3-5 CUPSOVER 5 CUPSDON’T DRINK COFFEE AT ALL

DO YOU TAKE SUPPLEMENTS? *NOYES

SELECT WHICH ONES *

DO YOU SMOKE REGULARLY? *NOYES

WHAT DO YOU THINK OF YOUR DRINKING HABITS?I DO NOT DRINKI DRINK SOMETIMESI DRINK FREQUENTLY

DO YOU HAVE FREQUENT WEIGHT FLUCTUATIONS? *NOYES

DO YOU HAVE ANY ALLERGIC REACTIONS TO FOOD? *NOYES

DESCRIBE THEM *

PLEASE DESCRIBE PAST OR CURRENT MUSCULOSKELETAL CONDITIONS YOU HAVE INCURRED IF YOU HAVE ANY *

HEAD – NECKUPPER BACKSHOULDERS – CLAVICLESARMS – ELBOWSWRIST – HANDSLOWER BACKHIP – PELVISTHIGHOTHERNONE OF THE ABOVE

DO YOU TAKE ANY MEDICATIONS, EITHER PRESCRIPTION OR NON-PRESCRIPTION, ON A REGULAR BASIS WHICH AFFECT ON YOUR ACTIVITY? NOYES

SELECT WHICH ONES

CAN YOU LOSE YOUR BALANCE DUE TO DIZZINESS OR HAVE YOU EVER LOST CONSCIOUSNESS *NOYES

PLEASE LIST THE FOLLOWING DISEASES / DISORDERS WHICH DISTURB YOU (IF YOU HAVE ANY)

COLDS PER YEAR1-2 TIMES3-4 TIMESMORE THAN 5 TIMES

ANEMIA1-2 TIMESMORE THAN 3 TIMES

GASTROINTESTINAL DISORDER1-2 TIMES3-4 TIMESMORE THAN 5 TIMES

HYPOGLYCEMIA1-2 TIMESMORE THAN 3 TIMES

THYROID DISORDER1-2 TIMESMORE THAN 3 TIMES

PRE / POSTNATAL1-2 TIMESMORE THAN 3 TIMES

PLEASE LIST IF YOU ARE PERSONALLY EXPERIENCING ANY OF THESE CONDITIONS (IF YOU HAVE ANY)

ASTMADIABET TYPE 1DIABET TYPE 2EPILEPSYOSTEOPOROSISHIGH BLOOD PRESSUREHIGH CHOLESTEROLHYPERLIPIDEMIAHEART DISEASEHEART ATTACKANGINASTROKEGOUTANOREXIA – BULIMIAOTHER PAIN OR IMITATION THAT MUST BE ADDRESSED WHEN DEVELOPING AN EXERCISE PROGRAMNONE OF THE ABOVE

PLEASE SELECT THE FITNESS GOALS YOU WOULD LIKE TO ACHIEVE IN THE NEXT 1–3 MONTH?

GET SHAPEFLEXIBILITYSTRENGTHGET LEAN MUSCLESLOSE WEIGHTBURN FATGAIN WEIGHTINCREASE IMMUNE SYSTEM

HAVE YOU HAD ANY SURGERY OPERATION IN THE LAST YEAR? *NOYES

DO YOU HAVE TRAINING PROGRAM? *NOYES

HOW DO YOU RATE HEALTH IN YOUR LIFE? *LOW PRIORITYMEDIUM PRIORITYHIGH PRIORITY

HOW COMMITTED ARE YOU TO ACHIEVING FITNESS GOALS? *VERYSOMEWHATNOT VERY

UPLOAD PHOTOS *

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Up to 3 photos (10 MB per photo) full-height body from different angles. Please upload at least 1 photo.

PLEASE MAKE ANY OTHER COMMENTS WHICH YOU CONSIDER AS IMPORTANT TO YOUR EXERCISE

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