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1st Mood-Based Workout App
Quiz: What Kind of Fit Girl Are You?
Healthy Lifestyle Quiz
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Book Call
Resources
1st Mood-Based Workout App
Quiz: What Kind of Fit Girl Are You?
Healthy Lifestyle Quiz
About + Contact
Sign In
My Account
The L3 Method Day Zero Questionnaire
The L3 Method Day Zero Questionnaire
Name
*
First Name
Last Name
Phone
*
Country
(###)
###
####
Email
*
First and foremost please describe ALL of your goals.
*
Please be as detailed as possible.
Height
*
Current Weight
*
Highest Adult Weight
*
Desired Body Weight
*
Weight 1 Year Ago
*
Age
*
Where do you live?
*
(City, State, Country)
What is your primary time zone?
*
(ex: PST, CST, EST, etc.)
How often do you travel for work and/or for pleasure?
*
0-2x per year
3-4x per year
Approximately every other month
1x per month or more
Is there a specific event you are training for? If so, please provide type of event and date
*
Do you have children? If so, what are their ages?
*
Are you currently pregnant?
*
No
Yes
Do you smoke?
*
No
Rarely
Yes
Do you drink alcohol?
*
If so, how many drinks?
No
Yes, 1-2 drinks per month
Yes, 3-4 drinks per month
Yes, 1-2 drinks per week
Yes, 3-4 drinks per week
Yes, 5-6 drinks per week
Yes, more than 6 drinks per week
Do you have high cholesterol?
*
No
Yes
Has your doctor ever said that you have heart trouble?
*
No
Yes
Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?
*
No
Yes
Has your doctor ever told you that your blood pressure was too high?
*
No
Yes
Please list all injuries, surgeries and/or hospitalizations within the last two years
*
Please list any current medications you may be taking that could be affected by exercise.
*
Any other injuries, health conditions and/or physical limitations to know about?
*
Please describe in detail.
Do you ever feel weak, fatigued, or sluggish?
*
No
Yes
Do you often experience digestive difficulties?
*
Yes
No
Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?
*
No
Yes
How would you rate your current level of fitness?
*
Poor
Fair
Decent
Awesome!
How would you rate the activity level of your profession, or what you do during the day?
*
Sedentary
Moderately Active
Active
Very Active
What is your current level of experience with lifting and resistance training? (All levels are welcome)
*
Beginner
Intermediate
Experienced
Advanced/Expert
How long have you been exercising?
*
How many times per week would you like to exercise?
*
This includes ALL exercise, cardio, resistance training, fun outdoor activities done solo or with family, friends, etc.
2
3
4
5
6 or more
What are your preferred times to train? Please give all specific days and times.
*
Where do you plan on working out?
*
At Home
At The Gym
Outdoors
Home and Gym
Home and Outdoors
Gym and Outdoors
All Three
If working out from home or outdoors, we will be using a few dumbbells, ankle weights, bands, a yoga mat and a ball. Do you have access to these or are you willing to obtain this equipment?
Yes, I have all of this equipment already.
Yes, I have some of this equipment and will grab the rest.
No, I don't have any of this equipment but I'm willing to go get these items.
No, because I will working out at the gym.
Is accountability important to you?
*
Yes
No
Not Sure
Have you ever worked with a personal trainer?
*
No
Yes
If so, please describe your experience and results.
Have you ever worked with a nutritionist or registered dietician?
*
Yes
No
If so, please describe your experience and results.
Do you know what your current macros are? (It's okay if you don't)
*
Are you currently taking an supplements? If so, please list all with daily dosages.
*
Please check off all that apply.
*
Low Fat
No Gluten
Diabetic (Type II)
Pre-Diabetic (Type II)
Low Carb
Vegetarian
No Dairy
High Protein
Vegan
Paleo
Low Sodium
High-Sodium (for low blood pressure, etc)
High Raw
Full Raw-Foodist
Jain
Other
What are you most interested in? Please check all that apply.
*
Fat burning
Growing my booty!
Seeing my defined abs
Snatching my waist
Toned, defined arms, shoulders and back
Toned, defined legs
Mobility, balance and injury prevention
Better posture
Full body strength
Increased stamina and endurance
Improve overall health
Other
What time do you typically wake up in the morning on weekdays?
*
What time do you typically go to sleep on weekdays?
*
Walk me through your typical weekday breakfast. Please provide as much detail as possible, what time you eat, volume of each food, brands of foods if applicable and any toppings, condiments, sauces, seasonings and/or accompanying beverages.
*
Walk me through your typical weekday lunch. Please provide as much detail as possible, what time you eat, volume of each food, brands of foods if applicable and any toppings, condiments, sauces, seasonings and/or accompanying beverages.
*
Same with weekday dinner options – what time, who's preparing dinner usually, how much of each food, brands used if applicable, condiments, sauces, seasonings, broths, beverages, etc.
*
Now walk me through all AM and PM weekday snacks, if applicable.
*
Would you say you have more of a sweet tooth or a salty/savory tooth?
*
Sweet
Salty/Savory
Both
Please describe all the ways your weekends can vary from your weekdays, as is relates to sleep times and all meals.
*
What are some of your favorite cheat meals?
*
Please give as much detail as possible
What are some healthy foods you enjoy most?
*
Imagine this scenario: you're stuck on a mystical island and told you must choose only one meal to eat for the rest of your life. What would it be?
*
How much water do you consume on average each day?
*
16 fl oz or less
32 fl oz
48 fl oz
64 fl oz
80 fl oz
96 fl oz
128 fl oz
More than a gallon
No idea
Do any of these describe you?
*
Please check all the apply
Fast Eater
Erratic Eater
Emotional Eater (stressed, bored, sad, etc.)
Binge Eater
Late–Night Eater
Negative Relationship with Food
Travel Frequently
Do Not Plan Meals/Menus
Exercise Excessively to Compensate for Overeating
Family Member(s) Have Different Tastes
Self–Proclaimed Foodie
Rely on Convenience Items
Time Constraints
Dislike “Healthy” Food
Confused about Food/Nutrition
Frequently Eat Fast Food
Please list any known allergies, sensitivities, intolerances, diet restrictions or limitations for any reason (health, cultural, religious, ethical or other.)
*
Thank you for taking the time to fill this out! Please add any remaining noteworthy details here.
*
Thank you!
