Information Collection

Name *

First

Last

Email *

Address

Birth Day

Height (cm)

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Weight (kg)

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Define your goal with the timeline.

Describe your current training briefly (Reps, sets, frequency etc)

Describe your cardio (Duration, intensity & frequencies)

Describe your current diet (What you eat? How you eat? How many meals? Teas & Coffees, sugar intake etc)

Please list all current & recent prescriptions if any (All the medications)

Please list down current & recent supplements

Any injuries/physical limitations?

Any current & recent health issues, conditions, food allergies or intolerances?

Body composition assessment

List me 3 foods that you cannot live without?

Preferred food to be included in the plan diet (Preferences for protein, carbs & fat)?

Do you meditate, if yes how often?

Body composition assessment

Neck (cm)

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Chest (cm)

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Hip (cm)

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Waist (cm)

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Thighs (cm)

Selected Value: 0

Calves (cm)

Selected Value: 0

Biceps (cm)

Selected Value: 0

Submit

Once completed, attach this form along with 2-4 current pictures and any additional recent contest
pictures to our email dulangalakmal007@gmail.com Pictures must be clear with your front, back & both
the sides.

By submitting this application you agree with the following:

I (the applicant) promise that I am providing an honest, comprehensive and complete history of all pertinent health, supplementary and dietary information. I understand that not disclosing relevant information could lead to less optimal results and further risk my own health.