Full Name

Email Address

Age

Phone Number

How did you hear about us?

How tall are you?

How much do you weigh right now?

What is your goal weight?

Do you currently track your food intake? If yes, pleases describe how you track and what are your average daily macronutrient levels in grams.

What foods do you love to eat?

What foods do you hate to eat?

Do you have any food allergies? If yes, please describe.

Do you have any medical conditions/issues that we need to be aware? If yes, please describe.

Any previous injuries? How about just nagging pain? if yes, please describe.

What kind of diet did you use to attain your best condition in the past?

Where do you train at? Home gym, school, work, or a commercial gym?

What kind of training do you do? How many days a week, volume, intensity, duration, etc. Do you do any cardio? What kind? We want to get an idea of your training experience.

Explain the gym equipment you have readily available to you.

What kind of supplements do you take, if any? Describe your supplement regime and dosages.

What time of day will you be working out?

What times of the day can you eat?

Do any of your meals need to be shakes based on work restrictions? Do you have a specific brand or flavor you currently use and want us to implement? If yes, please describe.

Most importantly - what are your primary goals? What exactly would you like to see happen with your physique or with your training / nutrition program?

Any additional information that you think we would need to know about your food, fitness, or lifestyle. If you have a concern that you want to be considered in your program, this is a great time to fill in the gaps of the questionnaire.

LIABILITY AGREEMENT, CANCELATION POLICY, AND WAIVER: The undersigned recognizes that the use of JD FITNESS LLC services involve an inherent risk of physical injury including that caused by the negligence of the undersigned, or contractors and employees of JD FITNESS LLC. The undersigned hereby agrees to assume the risk of injury in its entirety regardless of the cause. JD FITNESS LLC, or contractors and employees of JD FITNESS LLC shall not be liable for injuries or damages to the undersigned, or the property of the undersigned, or by subject to any claim, demand, injury, death, or damages whatsoever, including, without limitation, those damages resulting from acts of active or passive negligence on the part of JD FITNESS LLC, or contractors and employees of JD FITNESS LLC for all such claims, demands, injuries, death, damages, actions, or causes of action. It is specifically agreed that JD FITNESS LLC, or contractors and employees of JD FITNESS LLC shall not be responsible or liable to the undersigned for articles lost or stolen in connection with JD FITNESS LLC, or contractors and employees of JD FITNESS LLC service’s. The undersigned also recognizes and understands fully the cancellation policy required to give JD FITNESS LLC Twenty Four (24) hour written notice for any appointments that need to be cancelled to insure no charged, or the deduction of a previously purchased session as a replacement. By checking the "I have read and understand" box and entering your full name in the field below, you are electronically signing and agreeing to the entirety of this policy and waiver upon submitting your questionnaire. LIABILITY AGREEMENT, CANCELATION POLICY, AND WAIVER: The undersigned recognizes that the use of JD FITNESS LLC services involve an inherent risk of physical injury including that caused by the negligence of the undersigned, or contractors and employees of JD FITNESS LLC. The undersigned hereby agrees to assume the risk of injury in its entirety regardless of the cause. JD FITNESS LLC, or contractors and employees of JD FITNESS LLC shall not be liable for injuries or damages to the undersigned, or the property of the undersigned, or by subject to any claim, demand, injury, death, or damages whatsoever, including, without limitation, those damages resulting from acts of active or passive negligence on the part of JD FITNESS LLC, or contractors and employees of JD FITNESS LLC for all such claims, demands, injuries, death, damages, actions, or causes of action. It is specifically agreed that JD FITNESS LLC, or contractors and employees of JD FITNESS LLC shall not be responsible or liable to the undersigned for articles lost or stolen in connection with JD FITNESS LLC, or contractors and employees of JD FITNESS LLC service’s. The undersigned also recognizes and understands fully the cancellation policy required to give JD FITNESS LLC Twenty Four (24) hour written notice for any appointments that need to be cancelled to insure no charged, or the deduction of a previously purchased session as a replacement. By checking the "I have read and understand" box and entering your full name in the field below, you are electronically signing and agreeing to the entirety of this policy and waiver upon submitting your questionnaire. I have read and understand the liability agreement and cancelation policy.

Full Name E-Signature