Personal Fitness Training in Arlington, Virginia, Washington DC - NuWeights.com

Free Assessment Questionnaire

Contact Information   First Name: Last Name: Address Line 1: Address Line 2: City: State: Zip: Country: Email: Phone: Unit of Measure   Select the unit of measure you wish to use for height and weight entries: English (inches, lbs)   Metric (cm, Kg) Personal Information   Sex: Female Male Pregnant/Nursing: n/a Pregnant Nursing Height: inches/cm Age: Body Frame   If you don't already know your body frame type, try this: place your thumb and middle finger around your wrist. If they overlap, enter "small." If they just touch, enter "medium." If they don't touch, enter "large." Body Frame: Small Medium Large Activity Level   Check the appropriate activity level that most closely approximates your lifestyle. Examples: Sedentary = working behind a PC. Moderately Active = waiting tables. Active = construction work. Activity level: Sedentary Moderately Active Very Active Body Weight   Present Weight: lbs/Kg     Desired Weight: lbs/Kg Desired loss/gain per week: 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.5 3.0 lbs/Kg Body Weight Charts for Women  |  Body Weight Charts for Men Daily Exercise Calorie Expenditure Goals   Exercise Calorie Goal - Monday: calories Exercise Calorie Goal - Tuesday: calories Exercise Calorie Goal - Wednesday: calories Exercise Calorie Goal - Thursday: calories Exercise Calorie Goal - Friday: calories Exercise Calorie Goal - Saturday: calories Exercise Calorie Goal - Sunday: calories Exercise Calorie Expenditures Sorted by Activity   |  Exercise Calorie Expenditures Sorted by Intensity Personal Goals   This selection is optional. Please select the option that most closely describes your goal: Lose Weight Maintain Weight Gain Weight Increase Athletic Performance Peak Body Weight   What is the most you ever weighed?: lbs/Kg When did you weigh this amount?: This is my present weight. Within the past three months. Within the past six months. Within the past 12 months. Within the past two years. Within the past five years. More than five years ago. Medical Conditions   Please select as many as apply below. If none apply, please check "None."   Anemia Asthma Colitis Diabetes Gastric Reflux Hypertension Hypoglycemia Irritable Bowel Syndrome Heart Disease Hiatal Hernia Liver Disease Other (specify): None How Did You Hear about NuWeights?   Please let us know how you heard about NuWeights.  Select One Search Engine Referral Other If "Other," please specify:  All assessment information is based on the dietary guidelines for "healthy individuals." Please consult your doctor before beginning a diet program.