Please enable JavaScript in your browser to complete this form.1234Email *Date of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleWhat are your short term goals (next 3-6 months)? *Some examples of short-term goals: a competition (with date), a wedding (with date), vacation, photoshoot, beach. If there is no event you are dieting/training for, "improve my health" is also a valid answer.What is your blood type?A+A-B+B-AB+AB-O+O-do you get angry easily ? or are you sensitive at all?YesNONextYOUR BACKGROUNDWhat is your injury/illness history? Do you have any physical limitations that would prevent you from being able to perform certain exercises?Do you have injuries or limitations that prevent you from doing certain exercises? What exercises can you not perform?Go into as much detail as possible. Provide the supplements of ALL KINDS you have taken in the past and in what amountsPlease include dosages. Essentially, Amin needs to know everything about your supplementation over the past year. It makes a HUGE difference to know what has been going on. Describe if you did PCT and what your PCT was or if you’re on HRT or blast and cruise. Without this info, Amin cannot design an optimal plan. CURRENT STATUSActivity level *Sedentary ( little or no exercise, desk job )Lightly active ( light exercise/sport 1-3 days/week )Moderately active ( moderate exercise/sports 6-7 days/week )very active ( hard exercise every day or 2 time/day )Describe your job and activity level and what time in the day you are busy with that (also Average wake-up and bedtime time every day )? *It is helpful to know how many hours you spend at work per day/week in addition to how active you are at your job. This information will help Amin understand how long you have to eat and prep in the morning.What are your possible training times for each day and for how long?How many days you can train per week? Do you have to take any specific days off? Are you flexible in how often you can train?For example, some client's gyms are closed on Sundays or have a family day or have a long workday where the gym is not realistic for them on that day.NextDiet & foodProvide all of your food allergies/intolerances/diagnosed medical conditions/celiac *Please list all potential concerns, such as can't eat gluten, eggs, nuts, almond milk, etc.... or digestive issues or High levels of stomach acid What are some foods you do not like the taste of and will not want to eat?For example, some people hate most fish but like certain kinds like salmon or spinachWhat are your favorite less healthy or junk type foods?Which meal in your day do you like to eat more on that ( you prefer it and can eat more in that meal )?How is your appetite?NextFront Photo Click or drag a file to this area to upload. Back Photo Click or drag a file to this area to upload. Side Photo Click or drag a file to this area to upload. Please provide any other information that you think may help Amin as he makes your planThe more info you provide, the better Amin can individualize the program to your specific needs.Submit
