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Contact
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Transformations
Questionnaire
Eimear
2020-04-28T11:47:44+00:00
New Member Questionnaire
Step
1
of
5
- About You
20%
Name
First
Last
Email
Height (cm)
Weight (kg)
Goals
Please select 3 that most apply to you
Improve Health
Improve Endurance
Improve Strength
Improve Muscle Mass
Weight Loss
Mass Gain
Sport Specific
Do you have a specfici goal in mind? (target weight, body fat % etc)
If you have, do you have a specific timeframe?
What do you do for work?
Does your job involve shift work?
Yes
No
Do you have any children?
Yes
No
What is your fitness/strength training experience?
Beginner
Intermediate
Advanced
How many times a week do you currently exercise?
If you are not currently exercising, have you ever been on a constant exercise programme?
Yes
No
How long ago was it and how long did it last?
Are you able to exercise for 3 hours per week?
Yes
No
Are you able to spend 30 mins per day preparing food?
Yes
No
Do you smoke?
Yes
No
How many times per week do you drink?
I don't drink
1-3
4-5
6+
Do you have any diagnosed health conditions?
Are you currently taking any regular medication?
Please list any current or previous injuries:
Joint Health
Do you suffer from any of the following?
Aches / pains in joints
Aches / pains in muscles
Arthritis
Stiffness or limits of movement
Feelings of weakness / tiredness
General Health
Do you suffer from any of the following?
Headaches
Dizziness
Asthma / Bronchitis
Difficulty breathing
Shortness of breath
Hives, Rash, Dry skin
Hot flushes
Irregular heartbeat
Stuffy nose
Chest congestion
Frequent illness
Hair loss
Excess sweating
Chest pain
Excess weight gain
Fatigue
Anxiety / nervousness
Cravings
Restlessness
Water retention
Sleep
Do you...
Have trouble falling asleep?
Difficulty waking up in the morning
Sleep less than 7.5 hours a night
Wake more than once in the night
Wake up feeling tired
Only wake with alarm
Regularly go to bed after 11pm
Struggle to fall asleep at night
Use medication to sleep
Do you suffer from any of the following?
Indigestion / Heart burn
Gas or Belching
Constipation
Diarrhoea
Please list any foods that make you feel uncomfortable after eating:
Do you regularly feel full after meals?
Yes
No
Do you suffer from bloating 1 hour after meals?
Yes
No
Do you have less than 1 bowel movement per day?
Yes
No
Please give an example day of meals/eating:
Breakfast
Please give an example day of meals/eating:
Lunch
Please give an example day of meals/eating:
Dinner
Please give an example day of meals/eating:
Snacks
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