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FitWhit Questionaire
First Name
Last Name
Email
Phone
Birthday
Occupation
Age
Height
Current Weight
Daily Activity (not including exercise, not including workouts)
Sedentary (Desk Job)
Moderate (on feet a lot)
Active (construction worker)
How many days a week do you currently workout?
How many minutes is your workout?
Do you workout at home, a gym, or with a trainer?
Which category would you describe yourself during a workout?
-light activity (100-300 calories burned)
-moderate activity (300-500 calories burned)
-very active (500+ calories burned)
What is your current diet like?
Have you counted macros before? If so, when and what are/were your macros?
Any history of eating disorder? (Completely confidential, but pertinent information) Any medical limitations, including food allergies?
Is the anything else I should know or that you would like to share that will help us reach your goals together?
What are your non-scale goals?
Are you experiencing any hormonal disorders or changes?
PCOS
Hysterectomy
Partial Hysterectomy
Pre-menopausal
Menopause
Post-menopausal
How many alcoholic beverages do you currently consume? *(This information is pertinent to caloric intake only.)
0
1 per day
2 per day
1-2 per week
3-4 per week
When is the best day to contact you for checking in?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
When is the best time of day to check in with you?
Which method of conference would you prefer?
*
Text
Email
Video Conference
Submit
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