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Questionnaire
Your Name
IG Handleyour instagram name
City
Sex
Age
Height
Current Weight
Goal Weight
Time Frame
Do your family and friends support your goal?
Describe what you eat in a typical day:
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Describe your overall goal and ideal physique:
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Do you want a meal plan based on convenience or variety?
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Do you have any food allergies or any foods that you will not eat?
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What time of day do you workout?
Do you have a gym membership?
Do you have any experience with weight training?
Do you drink coffee? If so, how to do you take your coffee?
Does your job allow you to eat 6 meals a day? If not, how many meals can you reasonably fit into your daily routine?
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Do you smoke?
What are your weaknesses when it comes to proper diet and nutrition?
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How many days per week are you able to commit to a consistent workout?
What areas would you like to improve on your physique?
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How did you hear about Gauge Girl Training?
Is this your first time working with Gauge Girl Training?
Check any ALLERGIES you have:
Other Allergies:
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Check any PROTEIN sources you WILL NOT eat*Failure to check off an item may result in the inclusion of that food in your program. If you DO NOT explicitly exclude it here, your program cannot be revised.
Check any CARB SOURCES you WILL NOT eat:Failure to check off an item may result in the inclusion of that food in your program. If you DO NOT explicitly exclude it here, your program cannot be revised.
Check any Fruit and Veggie Sources you WILL NOT eat:Failure to check off an item may result in the inclusion of that food in your program. If you DO NOT explicitly exclude it here, your program cannot be revised.
Check any fats you WILL NOT eat:Failure to check off an item may result in the inclusion of that food in your program. If you DO NOT explicitly exclude it here, your program cannot be revised.
Are you pregnant or breast feeding?
If breast feeding, approximately how many ounces do you lactate per day?
What exercises can you not perform?
Have you ever experienced an eating disorder?
If yes, please describe...
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Are you currently being treated for an eating disorder?
IF YES, THIS PROGRAM IS NOT FOR YOU and we recommend seeking guided medical support from a qualified medical specialist. Please contact the national eating disorder association at nationaleatingdisorders.org.
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Please review your answers for accuracy. Any dietary or training needs NOT
mentioned will NOT be accounted for in your program UNLESS THEY ARE EXPRESSLY WRITTEN.
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