How many glasses of water do you drink pr day? a Do you ever fel drops to your nergy lavel throughout the day? How mony times per week do you est out? 0 you do your own grocery shopping? __ Yes _No Do you do your own cooking? Yes __ No Besides hunger, why else do you find yourself eating? Do you find thet you eat past the point of fullness? Do you find yourself esting foods that are high in fat end sugar? fees of your nutrition that you would lke to improve on: How often do you participate in physical exercise per week? |f you would like to exercise more often, please list the reasons you are not? ‘What physical activities are you currently involved vith? How do you prefer to exercise? Plesse circle all that appv. ‘What are the days of the week that you would lke to commit to a personal traning program? Please list time Intervals you are available, LUst in order of pririty your fitness goals that you would like to achieve in the next four to twelve months? Aff ustanpormemess