Lean Bulk Program Personal InformationFitness GoalLifestyleBodyExerciseNutritionConfirmPersonal InformationName*Gender*MaleFemaleOccupationAge*SelectUnder 1818-2425-3435-4445-5455-6465 or overDate of BirthEmail *PhoneAddressCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'IvoireCroatia (Local Name: Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia, South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweNextFitness GoalLong Term Goal*For Example : I want to get bigger and stronger.Short Term Goal*For Example : I want to achieve my strength back.I want to...GainMaintainHow much do you want to gain?*SelectKgs. 1-5Kgs. 6-10Kgs. 11-15Kgs. 16-20Kgs. 21-25Kgs. 25+How much do you want to loose?*SelectKgs. 1-5Kgs. 6-10Kgs. 11-15Kgs. 16-20Kgs. 21-25Kgs. 25+CommentsBackNextLifestyle & HabitsDescribe Yourself!What time do you usually go to bed at night?What time do you usually wake up in the morning?On a scale of 1 to 10 (1 = no stress, 10 = a lot of stress), please rate the amount of stress in your Life.12345678910What kind of lifestyle do you have?*SedentaryNormally ActiveVery ActiveExtremely ActiveAre there any other notes about your lifestyle that you would like to share?BackNextBody Composition & Medical Your Height*Ft. In.Your Weight*Kgs.Body Fats%Do you suffer from back pain?*YesNoPlease give details...*Do you have tension, numbness or pain in a specific area?*YesNoPlease give details...*Do you experience frequent headaches?*YesNoPlease give details...*Are you pregnant?*YesNoPlease give details...*Do you have high blood pressure?*YesNoPlease give details...*Do you have high cholesterol?*YesNoPlease give details...*Have you ever had surgery?*YesNoPlease give details...*Have you ever broken any bones?*YesNoPlease give details...*Have you ever been advised by a physician to avoid any type of exercise?*YesNoPlease give details...*Do you or does someone in your family have a cardiac condition?*YesNoPlease give details...*Do you have any known allergies?*YesNoPlease give details...*Are you currently taking any medications, including nutritional supplements?*YesNoPlease give details...*Do you smoke or have you smoked in the past?*YesNoPlease give details...*Do you have any medical issues that have not yet been discussed in this questionnaire?*YesNoPlease give details...*Do you drink Alcohol?*YesNoBackNextExercise History & Planning Are you currently exercising?*YesNoHow long have you been training?Years.How many days you exercise per week?Select1231234567DaysHow long do you exercise?Years.What is the intensity of your training?LightModerateHeavyVery HeavyWhat is your favourite exercise? What is your weakest body part?On a scale of 1 to 10, How would you rate your present fitness level (1= worst – 10= Best)?*12345678910 How and where you would like to perform exercise?*HomeGymOutdoorsWhat type of workouts you prefer ?*Machines BasedFree WeightsBody WeightsHow many days you can dedicate to your training per week?*Select1231234567How many hours a day you can dedicate to your training?*Select30 Minutes45 Minutes1 HourMoreWhat time would you prefer to exercise?MorningAfternoonLate AfternoonEveningBackNextNutritionChoose more options to have more variety in your diet plan!Do you count or track calories?YesNoIf yes, please mention your calorie intake and macros How many meals you take a day?*1234566+What is your breakfast?*What is your lunch?*What is your Dinner?*Snacks in between breakfast, lunch and dinner:Describe all nutritional supplements you are currently using. Including multi-vitamins, sport supplements, electrolytes, and any special juices, pills, capsules or tablets:How much water do you drink per day?* < 1 Litres1 Litres2 Litres3 Litres3 > LitresPlease specify which meat products you would NOT prefer?BeefLambGoatChickenTurkeyFishPlease specify which Veggies and Grains you would NOT prefer...BrocolliSweet PotatoesBeansSpinachPotatoesOatsGreen BeansWhite RiceQuinoaPeasBrown RicePastaLentilsMixed SaladMashroomsCornsAsparagusCapsicumWholegrain BreadMultigrain BreadAny otherIf any other, please specify...Tell us which fruits listed below you would NOT prefer...AppleBananaOrangeWatermelonPumpkinBerriesPineappleGrapefruitAvocadoMandarinKiwiPomegranateAny otherIf any other, please specify...Tell us which product listed below you would NOT prefer...EggNutsYogurtMilkPeanut ButterCottage CheeseTofuOlive OilDark ChocolateHoneyApple Cider VinegarAny otherIf any other, please specify...BackNextConfirmation & ThanksWe assume that all the information you have provided so far are accurate, based on that we will design a program for you*Yes, it is.Please allow us up to 1 to 5 business days to send you the nutrition plan. Thank you very much for choosing Nashaat Zone Personal Training for your body’s Transformation. Administration - Nashaat ZoneBackSendThis field should be left blank