Big Day HC - Free Online Fitness Assessment

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Health-Fitness-Support

FREE ONLINE HEALTH ASSESSMENT

Please fill in the details below as accurately as you can so we can recommend the most efficient and healthiest way to achieve your desired results for your Big Day. This will take around 10 minutes to complete.

PERSONAL DETAILS
First Name:	(Required)
Surname:
Address:
Suburb/Town:	(Required)
State:	(Required)
Postcode:
Email address:	(Required)
Phone:	(Required)
Age:
Weight (Kg): (measured in morning before eating)
Height (cm):
Current Dress Size:
Body Fat% (if known):
Goal Weight/ Dress Size:
WEDDING DETAILS
Date of Wedding:
Date of Final Dress Fitting:
Number of Bridesmaides:
Location of Wedding:
DIET ASSESSMENT
Do you have breakfast?	Yes No
Lunch?	Yes No
Dinner?	Yes No
Snacks per day (including after dinner)?	None 1 2 3 4
Serves of fruit per day?	None 1 2 3
Serves of vegetables per day?	None 1 2 3 4 5
Serves of dairy products per day?	None 1 2 3
Do you eat low fat dairy products?	Yes No
Litres of water per day?	None 0.5 1 1.5 2 2.5+
Coffee/Tea per day?	None 1 2 3+
Softdrinks/Sportsdrinks per day?	None 1 2 3+
How many times a week do you eat out per week (including take-away)?	None 1 2 3+
Standard drinks of alcohol per week?	None 1-2 3-4 5+
Who cooks most meals at home?	You Partner Both
Food intolerances?	(Use CTRL-click to select more than one)
Any foods you can't eat?
Any other notes?
FITNESS CHECK
How many days per weeks do you exercise?	None 1 2 3 4 5+
Average length of session?	0-30 mins 30-45 45-60 60+
Cardiovascular sessions per week (including walking)?	None 1 2 3 4 5+
Strength training sessions per week?	None 1 2 3
Are you a member of a gym?	Yes No
Have you been a member of a gym in the past?	Yes No
Have you ever had personal training?	Yes No
Preferred method of cardiovascular exercise?	(Use CTRL-click to select more than one)
How many times do you play competitive sport per week?	None 1 2 3
What time of day do you prefer to exercise?	(Use CTRL-click to select more than one)
How many times per week is realistic for you to exercise?	2 3 4 5 6

Once you submit this information you will receive an email within two business days with your personalised recommendations for losing weight in the lead up to your wedding day. Thank you for taking the time to fill out your relevant details. Big Day Health Consultancy looks forward to working with you in the future to ensure you have a wonderful Big Day.

Directors – Andrew Skillern and Heath Maplestone