* 1. Name

* 2. Email

* 3. Height (in.)

* 4. Weight (lbs.)

* 5. Age

* 6. Please list the typical level of activity associated with your work and/or day.

* 7. How frequently do you exercise (days per week)?

* 8. List the average minutes / day you exercise. Please list the type(s) as well.

* 9. Intensity of exercise

* 10. Please rank the following goals in order of importance.

  Most important goal Least important goal
Fat loss
Build muscle
Performance improvement
Overall health improvement

T