( SPECIAL! EXPIRES 11/1/10 )
- Complete Grocery List
- List of Supplements for Men and Women
- Low Glycemic Index List
- Workout Routine Based on Goals
- Long Term Fat Loss Plan
- Detailed email response with my professional recommendation for reaching your goals
How do I get started?
- Use your credit card with the link below to purchase a program!
- Copy the form below, fill it out and email it to me at jaketiesleronlinetraining@gmail.com
- You will receive a confirmation email and your program will be written by me and sent to you within 24 hours!
FORM
Full Name:
Sex (Male or Female):
Stats Age Height Weight
Body fat% (if possible)
Muscle girth measurements: (optional): Waist, Chest, Bicep, Thigh
Workout What is your current exercise routine?
Any exercises you cannot do due to illness or injury?
Do you train at home or at a gym?
If at home, what equipment do you have?
Have you ever participated in organized athletics or rigorous activity?
Diet "Eating schedule: Breakfast, Lunch, Dinner (including snacks)"
Estimate your daily calories: Grams of Protein, Carbs, and Fat (optional)
Favorite breakfast, lunch and dinner choices: Favorite snacks healthy and unhealthy:
Foods you hate/will not eat:
Lifestyle Do you drink?
How many nights per week?
Do you smoke?
Rate your stress 1-10 (10 = very stressed)
Do you get 8 hours of sleep?
Rate your sleep 1-10 (10 = amazing sleep)
Do you have children that you live with? (optional)
Does your weight fluctuate month to month?
Supplements List supplements you currently are using:
List any medications currently being used: Food or supplement allergies:
Goals "What exactly do you want to accomplish physically? (be as specific as possible)"
Do you want to focus on losing fat, gaining muscle or both?
For Women: What are your problem areas and concerns?
Daily Schedule When do you wake up?
When do you workout?
When do you go to sleep?
Any time constraints for meals?
Job What do you do for work? (optional)
Does your job require you to be active or sedentary?
Rate your stress 1-10 (10 = highest)
