PERSONALIZED WORKOUT PROGRAM

by David Silva

General Instructions: Please fill out the form below as completely as possible. Fields marked with * must be correctly completed in order to get your fitness program done
Is it your first time ordering a workout program here *   Yes No
If not, please your workout code #  
Last name *  
First name *  
Address *  
City *  
State *  
Zip code *  
Country *  
Telephone : Home *  
Work  
Portable  
E-mail *  
Gender *   Male Female
DOB *  
Weight *   lb kg Body fat %
Height *  

Inches Cm

Smoker *
 

No Yes , How many daily

1. Please rate yourself: (for the fallowing questions use the rate 1 to 5)

characterize your present cardiovascular capacity  
characterize your present muscular capacity  
characterize your present flexibility capacity  

2.What do you want exercise to do to you:

improve cardiovascular fitness  
body-fat weight loss  
reshape or tone my body  
improve performance for an specific sport  
improve moods an ability to cope with stress  
improve flexibility  
increase strength  
increase energy level  
feel better  
enjoyment  
other  

3. How much are you willing to devote to an exercise program?
Resistance (weight lifting):
minutes/day
 days/ week
Endurance (cardiovascular) :
minutes/day
 days/ week

4. Are you involved in regular endurance exercise? If yes, please specify
A minutes/days days/week
A minutes/days days/week

5. What types of exercise interest you? (Yes or NO)
walking   Yes No
jogging   Yes No
swimming   Yes No
cycling   Yes No
strength training   Yes No
stationary biker   Yes No
tennis   Yes No
stretching   Yes No
other  

6. Do you belong to a Fitness Center or Gym?

  Yes No , if yes
name
location

7. Would you like your Fitness Program to include gym equipment? (No, if you just want exercise that not require equipment)
Yes No

8. Is there any part of your body you would like to concentrate on for any reason:

Yes No

 if yes, which part ?

9. Would you like to change your current weight ?
  Yes No
If yes, by how much?
gain lb kg
 
loose lb kg

10. Have you ever had any kind of health problem such as respiratory, spinal, heart, bone fracture, etc. or have you ever been advised by a doctor or any other physician to not participate on any kind of sport or exercise? If so, please explaining
 
 

11. If you have any other comment (background, health problem, goals, etc.) to make, in order to clarify any above question(s) or to help building the most appropriate fitness program, please do so:
 
 

 

Nutritional plan
If you would like to order the Nutritional plan, Please fill out the form below, If not Skip to Check out.
 
1 -Characterize your eating habits level (according to what you know about nutrition)
 
2- Do you eat fast food in your regular basis?
Yes No
(If yes, please specify)
 
 
3- Do you have the habit of adding extra sugar on your food (coffee, tea, shakes, etc.)?
Yes No
(If yes, how much and how often does it happen on a daily basis)
 
 
4- Do you usually  eat processed sweets like cookies, ice creams, cakes,  etc., ?
Yes No,
(If yes, how  often on weekly basis?)
 
 
5- Is there any kind of food you cannot eat for any reason? (allergies, doctor recommendation, etc.)
Yes No
(If yes, please specify)
 
 
6- Please briefly describe your daily meals, starting from the first one in the morning, until your last one before going to bed, mention the time when you usually take them
 
 
 
7- What is your favorite source of food? (vegetables, legumes, red meat, chicken, fish, fruits, etc.)
 
 
 
8- Where do you get most of your meals from? (cook at home, restaurants, frozen food, etc.)
 
 
 
9- What is the main reason of you getting this Nutrition Guide Plan? ( improve your life style, feel better, less tired, lose weight, gain weight, etc.)
 
 
 
10- If you would like to change your weight, please specify:
 
 
 
Disclaimer: "I understand this is a Nutritional Plan guide to combine with my Workout program, and I declare that I do not have any kind of Health Problem (like Diabetes, Anorexia, etc.), or I am not under any doctor or nutritionist recommendation which would go against the use of it partially or totally. I also declare that all the above information is true and accurate, releasing David Silva from any kind of liability"
 
I agree
 
How did you find about us?
 
 
 
Workout Program US$ 110.00
Nutritional Guide Plan US$ 75.00  
Total US$ 185.00

For better result we recomende buy Workout Program and Nutritional Guide Plan, However, if you are intereste in buy just one of then, click the link below
Workout Program Nutritional Guide Plan
 
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