Nutrition & Lifestyle Questionnaire

Powerful Training
Powerful People
Workshops & Courses

Nutrition & Lifestyle Questionnaire

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Age *

Weight (lbs) *

Height (inches) *

Sex *

Male Female Inter

I want to *

Gain Weight Lose Weight Maintain Weight

Activity Level *

When do you typically work out *

Check All That Apply *

Hypertrophy (body building style; multiple work sets/reps) Strength (power lifting, strength sports) Endurance (run, elliptical, bike, etc) Low Intensity (yoga, walking, gardening, etc)

Do you drink? *

Yes, frequently (3+ drinks per week) Yes, occasionally (1-3 per week) No

Do you smoke? *

Yes No

Please list any dietary restrictions or allergies *

Please list any lifestyle restrictions *

Submit

FitPOWER LLC
Powerful Training. Powerful People.

5425 W. Vliet Street
Milwaukee, WI 53208
(319)541-5686

Powerful Training
Powerful People
Workshops & Courses

Nutrition & Lifestyle Questionnaire

FitPOWER LLCPowerful Training. Powerful People.

FitPOWER LLC
Powerful Training. Powerful People.