The Fitness Factory's Diet/Cardio/Training Questionnaire

 
The following questionnaire will help Mike provide you with the most appropriate customized program. Please be sure to complete all fields. All of your responses will be mailed directly to Mike once you press the Submit button. After you submit the questionnaire, be sure to read the instructions on the following page. Please note that your diet plan will be sent to you within 2 to 4 weeks.
First Name: (required)
Last Name: (required)
Email Address: (required)
Phone Number: (required)
Fax Number: (required)
Age: (required)
Height: (e.g. 5' 6" - required)
Weight: (e.g. 135 - required)
Address1: (required)
Address2:
City: (required)
State: (required)
Zip: (required)
How much cardio do you do each day (in minutes, 0 for none)?:
What type of cardio?:
Do you have any injuries?:
If yes, please describe:
Please provide a threee day journal of food intake: (required)
When do you get up, go to bed, and train?: (required)
Describe your long-term physique goals: (required)
Please list any medical ailments or allergies: (if applicable)
 
  Questions or Concerns?   If you have any questions or concerns about this questionnaire, please contact Mike at beefcakedavies@aol.com.