"*" indicates required fields Account InfoName* First Last Email* Phone*✓ Valid number ✕ Invalid numberBirthdayMonth*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay*12345678910111213141516171819202122232425262728293031Year*2016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Mailing Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code CountryUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial 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XLWomen's 2XLMen's SMen's MMen's LMen's XLMen's 2XLFeet*634578Inches*12345678910110Weight707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263264265266267268269270271272273274275276277278279280281282283284285286287288289290291292293294295296297298299300301302303304305306307308309310311312313314315316317318319320321322323324325326327328329330331332333334335336337338339340341342343344345346347348349350351352353354355356357358359360361362363364365366367368369370371372373374375376377378379380381382383384385386387388389390391392393394395396397398399400401402403404405406407408409410411412413414415416417418419420421422423424425426427428429430431432433434435436437438439440441442443444445446447448449450451452453454455456457458459460461462463464465466467468469470471472473474475476477478479480481482483484485486487488489490491492493494495496497498499500501502503504505506507508509510511512513514515516517518519520521522523524525526527528529530531532533534535536537538539540541542543544545546547548549550551552553554555556557558559560561562563564565566567568569570571572573574575576577578579580581582583584585586587588589590591592593594595596597598599600Lb or Kg.LbKg.Have you had any of the following body analysis scans completed in the last 90 days?InBody AnalysisDEXA ScanBod Pod ScanOtherNoNo, but tell me moreLast Body Scan Date MM slash DD slash YYYY Feel free to upload your body composition scan results here. Drop files here or Select files Max. file size: 100 MB. Non-Activity Energy ExpenditureWhat is your occupation? How many hours do you sit during the day?Choose0123456789101112131415161718192021222324How many hours do you stand during the day?Choose0123456789101112131415161718192021222324What other sports-like activities do you regularly participate in? How many steps do you average per day?Goals · Habits · SleepWhat are your primary goals?Fat LossMuscle GrowthImprove StrengthImprove MobilityImprove BalanceImprove ConditioningImprove EnduranceIncrease Pull-UpsImprove Core StrengthIncrease Range of MotionGlute FocusPower FocusAestheticsImprove PostureGet 1st Pull-UpRun 5KRun 10KRun Half-MarathonRun MarathonComplete IronmanComplete TriathlonDo you have other primary goals not listed? What long-term goals do you have?Why do you want to pursue your long-term goals? (Keep asking yourself why after every answer until you can't)Have you ever achieved your goals before?Identify one goal you want to achieve in 30 Days Identify one goal you want to achieve in 3 months* Identify one goal you want to achieve in 6 months Body Composition Vision Drop files here or Select files Max. file size: 100 MB. Habits You Wish To ImproveBedtime RoutineBegin the day with self-careNo phone or email after waking upHydrate before & after mealsEat slowerMeditate after waking upStretch after waking upMeditate before sleepStretch before sleepLayout workout clothes before sleepPlanning the next 24 hoursReduce blue-light 2 hours before sleepMindful eatingPortion controlSnacking at nightOrdering food for convenienceBinge eat in the eveningOtherOther habits you wish to improve Identify one habit you wish to master right now Wake up, put gym clothes on, exercise Layout gym clothes before bed Wake up without phone use Set daily intentions after waking up Fall asleep without the TV on Practice hunger cues late at night Hydrate before & after meals Practice eating slowly Write down 1 win per day Eat 1 veg & 1 fruit per dayPlease rate the quality of your sleep. 1 2 3 4 5Please describe your nighttime routine.Do you charge your phone next to the bed? Yes NoDo you use your phone as an alarm clock? Yes NoPlease describe your morning routine.Energy & RecoveryRate your morning energy (1-5)*The first 3 hours after waking up. 1 = no energy; 5 = Abundance of energy.12345Rate your afternoon energy (1-5)*3 hours after a lunch meal. 1 = no energy; 5 = Abundance of energy.12345Rate your evening energy (1-5)*3 hours after a dinner meal. 1 = no energy; 5 = Abundance of energy.12345Rate your recovery after a moderate strength training session (1-5)*1= fatigued all day, and there is no chance to exercise the next day. 5 = energy is fully recovered the same day and 100% ready for another moderate workout the following day using different muscles.12345NARate your recovery after an intense strength training session (1-5)*1= fatigued all day, and there is no chance to exercise the next day. 5 = energy is fully recovered the same day and 100% ready for another intense workout the following day using different muscles. 12345NARate your recovery after a moderate cardio training session (1-5)*1= fatigued all day, and there is no chance to exercise the next day. 5 = energy is fully recovered the same day and 100% ready for another moderate cardio session the following day.12345NARate your recovery after an intense cardio training session (1-5)*1= fatigued all day, and there is no chance to exercise the next day. 5 = energy is fully recovered the same day and 100% ready for another intense cardio session the following day.12345NARate your daily energy/mood based on current routine (1-5)*Based on your current exercise routine and nutrition habits. 5 = I feel incredible and very happy!12345NutritionWhat is your biggest nutrition struggle?* Do you have any dietary preferences?No PreferenceGluten FreeDairy FreeVeganKetoPlant-ForwardPaleoWhole30Mediterranean DietKosherNo SeafoodNo Red MeatLow SugarLow CarbCarb CycleLow FatNo AvocadosNo OlivesNo TomatoesNo Blue CheeseNo CoconutNo OnionsNo Baked BeansNo BaconNo BroccoliNo CoffeeDo you have other dietary preferences not listed? Do you have any food allergens?* Yes NoWhat food allergens do you have?SoyMilkEggsWheatShellfishMolluskAll SeafoodAll DairyTree NutsWalnutsPeanutsPine NutsAlmondsDo you have other food allergens not listed? How much water do you drink per day? Ounces*How much sugar (grams) do you consume per day?Choose0-2526-5051-7576-100100-125125-150150-200200+Not sureHow often do you buy groceries?ChooseOnce a weekTwice a week3+ times a weekNo schedule or routinePlease provide a list of foods you usually keep on hand. Add RemoveWhat foods do you usually cook? Add RemoveHow do you normally like to cook?Very basic for most mealsI love making new recipesAnything but the microwaveI only cook on the weekendsOne pan or lessI love to grill30 minutes or lessOtherHow else do you like to cook? Describe a normal day of eating on weekdays (Mon-Fri). Describe a normal day of eating on weekends (Sat-Sun). Do you currently do any meal prep? If so, how often and for what meals? Do you enjoy leftovers? Yes NoDescribe your leftover preferences What do you have access to in your kitchen? Microwave Stove top with pots and pans Oven with baking sheets and baking dishes Blender Food Processor Crock Pot/ Slow Cooker Air Fryer Chopping boards with knives Fridge Freezer OtherWhat else is in your kitchen? Gym Environment & Exercise HistoryDescribe your exercise routine from the last 30 days.Describe your exercise routine from the last 2 years.Do you remember a time when you felt your best?Where will you exercise most frequently?* Local Gym (YMCA, CrossFit, Gold’s, Lifetime, Etc) Home Gym (Garage, Studio, Apt, Etc) BothLocal Gym EquipmentFull Gym (CrossFit)Full Gym (YMCA)DumbbellsKettlebellsSingle KettlebellSquat RackBarbellBenchAdjustable BenchBands 40" Big LoopsMini BandsFoam RollerSlam BallMedicine BallWall BallSwiss BallBosu BallYBellTRX (Suspension Straps)Jump RopePull Up BarCable MachineSledBattle RopesEqualizer Dip BarsLong Sand BagStrong Man Sand BagOlympic RingsBox (Bench, Cooler, Tall Ledge)TreadmillRowerSkiErgAssault BikeDo you have other equipment at your local gym not listed? Home Gym EquipmentDumbbellsKettlebellsSingle KettlebellSquat RackBarbellBenchAdjustable BenchBands 40" Big LoopsMini BandsFoam RollerSlam BallMedicine BallWall BallSwiss BallBosu BallYBellTRX (Suspension Straps)Jump RopePull Up BarCable MachineSledBattle RopesEqualizer Dip BarsLong Sand BagStrong Man Sand BagOlympic RingsBox (Bench, Cooler, Tall Ledge)TreadmillRowerSkiErgAssault BikeDo you have other equipment at your home gym not listed? Do you need equipment recommendations?DumbbellsKettlebellsSquat RackBarbellBenchAdjustable BenchBands 40" Big LoopsFoam RollerSlam BallMedicine BallWall BallYBellTRX (Suspension Straps)Pull Up BarSledBattle RopesEqualizer Dip BarsLong Sand BagStrong Man Sand BagBoxWhat is your favorite gym tool to train with?*DumbbellsKettlebellsBarbellBands 40" Big LoopsFoam RollerSlam BallWall BallYBellTRX (Suspension Straps)Jump RopePull Up BarCable MachineSledBattle RopesLong Sand BagStrong Man Sand BagOlympic RingsSchedule Local GymMonday: Preferred Workout Duration(Minutes)152030456075901201800Same duration throughout the week? YesTuesday(Minutes)152030456075901201800Wednesday(Minutes)152030456075901201800Thursday(Minutes)152030456075901201800Friday(Minutes)152030456075901201800Saturday(Minutes)152030456075901201800Sunday(Minutes)152030456075901201800Do you have a preferred day to rest?MondayTuesdayWednesdayThursdayFridaySaturdaySundayI will leave it up to youSchedule Home GymMonday: Preferred Workout Duration(Minutes)152030456075901201800Same duration through the week? YesTuesday(Minutes)152030456075901201800Wednesday(Minutes)152030456075901201800Thursday(Minutes)152030456075901201800Friday(Minutes)152030456075901201800Saturday(Minutes)152030456075901201800Sunday(Minutes)152030456075901201800Preferred Day To RestMondayTuesdayWednesdayThursdayFridaySaturdaySundayI will leave it up to youCardio PreferencesWould you like cardio added to your program?* Definitely! Not right nowSelect your favorite types of cardioTreadmillOutdoor RunningRow MachinePeloton BikeStationary BikeEllipticalStair climberAirdyne or Assault BikeJacob's LadderSkiergARC TrainerRecumbent BikePreferred Cardio Workout DaysMondayTuesdayWednesdayThursdayFridaySaturdaySundayMaximum Cardio Workout Duration152030456075901201800Exercise Preferences · LimitationsWorkout styles you find enjoyable?CrossFitCalisthenicsBodybuildingOrange TheoryF45HIITMetabolic ConditioningPure Strength (5, 3, 1 or 5×5 etc)Pure Power LiftingMinimalYogaPilatesCompound & MetConPeloton BikeInterval RunningEndurance RunningStair ClimberSwimmingRope ClimbingPower WalkingOther Favorite Workout Styles Do you have an all-time favorite workout?Injuries & LimitationsDo you have any current injuries or limitations?* Yes NoDescribe any injuries or limitations.* Do you have any notable past injuries?* Yes NoDescribe your past injuries.* Jumping Exercises Okay? (box jumps, burpees)* Yes, let’s jump! Not right now. OtherWhat are your jumping preferences?* List any exercises you do not want programmed. Integrations · App FeaturesDo you have a fitness tracking device to sync?Apple WatchFitbitGarminGoogle FitNot Yet But Tell Me MoreNoDo you have a sleep tracking device to sync?Oura RingApple WatchGarminFitbitGoogle FitNot Yet But Tell Me MoreNoAre you familiar with all integration features? I am good to go! Please send some info I could use some helpAre you familiar with your Member's Portal? I am an expert! I have logged in, but have questions I do not know how to log into my portalProvide a profile picture, please. Drop files here or Select files Max. file size: 100 MB. 35609
