My Food Survey

1. How many meals do you typically have per day? (including mid morning, afternoon snacks)

2

3

4

5

6 or more small meals

2. Which of the following sources of protein can be included within your meal plan? (Select all that apply)

3. Select all vegetables that you could dedicate yourself to eating if they were incorporated into your Meal Plan:

4. List 6 of your favorite fruits below

5. As far as Physical Fitness goes, what are your main concerns? (Select all that apply)

Upper body strength

Building arm muscles

Core strength (abs & back muscles)

Losing weight in the midsection

Lower body weight loss

Lower body firming and toning

Overall toning & strength training

Other

6. List any previous injuries or concerns that may hinder your performance of certain exercises. If this does not apply to you then simply type "N/A" or "none".

7. How many days per week do you exercise for at least 30 minutes?

8. How many days per week do you have available to dedicate to exercising for at least 30 minutes?

9. Which of the following machines for cardiovascular exercise are you comfortable with using? (Select all that apply)

Treadmill

Bicycle

Elliptical

10. Do you have a gym membership?

Yes, and I use it.

Yes, but I don't use it often.

Not yet, but I plan to get one.

No, I have all of the exercise equipment I need at home.