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Females, how many children have you given birth to:
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Please describe, if any, your current exercises |
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Have you or are you now on any type of diet plan?
If yes, describe diet, results and time frame. |
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Please describe your hobbies, especially physical activities,
such as hiking, biking etc. |
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Other activities you would enjoy, but just don't have the time. |
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Indicate any sports in which you are currently involved. |
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If you are not involved in any sports, list the types you would be interested in.
Examples:
Individual Sports {Running, Martial Arts, Boxing, etc.}
Team Sports {Football, Soccer, Basketball, etc.}
Outdoor Sports {Hiking, Biking, Jogging, etc.}
Indoor Sports {Swimming, Aerobics, Racquetball etc.}
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Please describe any medical problems |
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Please list any Vitamins, Supplements or medication you are taking. |
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Please list any serious injuries in the past or present, Describe how it happened. |
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Please list what you have eaten in the last week.
For example:
Breakfast: Clementines, chocolate milk
Lunch: Rice, Roast Duck & Pork, tea
Snack: Peanuts (airplane kind), ice cream
Dinner: BBQ chicken and coke
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| Monday |
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| Tuesday |
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| Wednesday |
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| Thursday |
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| Friday |
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| Saturday |
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Body Measurements (Inches) |
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Copyright (c) Natural Diet And Training Systems . All rights reserved. Updated 9/98
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