BMBB APPLICATION FORM BMBB Questionnaire PhoneThis field is for validation purposes and should be left unchanged.Full Name(Required)Email(Required)Telephone Number(Required)BirthdayHeightWeightDo you know your body fat % - if yes please let us know how it was measuredWhat is your goal body weight? (also goal body fat%- if you are familer with body fat)What has your weight been like in the last 3 months? Increasing Staying the same Decreasing What are your top 2 (health/fitness) goals you would like us to help you achieve in the next 3-6 months?(Required) Lose weight/drop body fat Gain muscle Improve overall health Sport specific goal Improve self confidence I just wanna look good Get ready for a special event (wedding/vacation etc) Get ready for a fitness competition Gain weight Other Select AllHave you ever worked with a personal trainer in the past? If yes, what was your experience like?Where do you normally workout?(Required) At at commercial gym (have membership) At a gym that does specialized classes (bootcamp/boxing/yoga etc) At a fully equipped home gym At home with minimum equipment At home without equipment I currently do not workout Other (sports, running etc) Select AllWe know gyms have been opened/closed/opened/closed so select all that apply If you work out at home, please list all equipment you have access to?In the last 6 months, how many times a week have your worked out with weights?(Required) I use to workout, but have not worked out or worked out regularly in the last 6 months I never workout 1-2 times per week 3-5 times per week More than 5 times per week I only do cardio type workouts How many times a week do you do cardio? How long are your cardio workouts and what type of cardio do you normally do?If you are currently active, what is your current workout split? (ie 3x a week - lower body, upper body, abs + cardio)What type of a workout program would you like us to build for you? Commercial gym workout Full home gym workouts (squat rack, cable machine, variety of dumbbells' and bands) Home workouts with minimum equipment (dumbbells and bands) I need to work with a trainer directly - I am not ready to do it on my own I am not sure How many days per week are you able to commit to working out, and how much time can you dedicate to each session?(Required)Do you have any current or past injuries? Please give us full detail(Required)On a level 1-10, 1 being the terrible and 10 being perfect, how would you rate your diet in the last 3 months?(Required)Have you followed (or do you currently follow) a diet program? Please describe below and include any relevant info we may need to know (success/failure etc)(Required)Do you, or have you ever in the past kept track of your calories, and/or macros?Do you have a basic knowledge of micronutrients (proteins, carbs, fats)?(Required)Do you have any food sensitives, allergies or special dietary needs (inlcuding vegan/vegertarian diets)?(Required)How many meals do you eat per day (snacks included) Ar eyou able to give us an idea what your general day may look like?(Required)How many meals a week do you eat out/have delivered - please give detail of what you have/order?(Required)On average how many alcoholic beverages do you consume per week (weekends included)?(Required)On average how many liters of water do you drink per day?(Required)Do you take any prescription medications, including birth control? Please list them belowDo you keep you keep track of how many steps you get per day? If yes, what's your avg steps/day #How many hours of sleep do you get per night?(Required)On a level 1-10, 1 being the low and 10 being the very high, how would you rate your stress level?(Required)How many hours a day do you spend sitting/working at a desk?Do you use any supplements? Please list belowOn a level 1-10, 1 being the lowest and 10 being the highest, what is your motivation level to reach your fitness goals?(Required)Are you willing to give us your 100% commitment and trust the process to get you to your goal?(Required)Is there anything else you would like us to know?
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