Form

The following questions are designed to give Shawn Finnegan information needed to evaluate your personal nutrition and fitness status. Simply eMail your answers, and Shawn will contact you with follow-up questions.

This information will be treated as privileged and confidential.

Date:
Name:
Age:
Occupation:
Telephone:
eMail:

1. Please number the following fitness objectives by order of personal preference.

a) Reduce body fat ___________
b) Increase lean body mass ___________
c) Increase strength, speed, and endurance ___________
d) Improve overall health ___________
e) Other ___________

2. Approximately how many calories do you eat per meal? ______ per day? ______

3. Approximately how many servings of complete protein (chicken, fish, turkey, eggs,
etc.) do you eat per day? ___________

4. Approximately how many meals do you eat each day? ___________

5. What are the average time intervals between each of your meals? ___________

6. Do you eat breakfast every day? ___________

7. How often do you perform cardiovascular exercise each week? ___________

8. What is the approximate duration of each cardiovascular session? ___________

9. Do you check your heart rate during cardiovascular exercise? ___________

10. How often do you weight train each week? ___________

CURRENT DIET

Please list the foods that you consume on a daily basis, per meal.

Be as honest and specific as possible.
Include portion sizes if known.

Meal #1 (Breakfast)

Meal #2 (Snack)

Meal #3 (Lunch)

Meal #4 (Snack)

Meal #5 (Dinner)

Meal #6 (Snack)