GENESIS QUESTIONNAIRE

Please fill the questionnaire in detail, for us to understand your

lifestyle & needs better and design your program accordingly:

1. FULL NAME-

2. AGE & DOB-

3. WEIGHT & HEIGHT-

4. PROFESSION-

5. FOOD PREFERENCE (VEG/NON-VEG)-

6. ARE YOU ALLERGIC OR SENSITIVE TO ANY FOOD?

7. WHAT’S YOUR AIM/REASON FOR JOINING GENESIS?

8. SINCE HOW LONG HAVE YOU BEEN WORKING OUT?

9. WHAT IS YOUR PRESENT/PAST WORKOUT SCHEDULE?

PLEASE MENTION IN DETAIL.

10. WHAT TIME DO YOU WORKOUT IN A GIVEN DAY?

11. WHERE DO YOU PREFER TO WORKOUT (GYM OR

HOME)?

12. HAVE YOU EVER CONSULTED A DIETICIAN? IF YES,

THEN PLEASE TELL ME THE DIET YOU HAVE BEEN
PRESCRIBED OR HAVE FOLLOWED BEFORE.
13. PLEASE FILL IN THE TABLE BELOW ABOUT YOUR
CURRENT EATING/DIET PATTERN:

APPROXIMAT MEAL FOOD YOU EAT

E TIME
1st Thing in
Morning
Breakfast

Between
Breakfast
& Lunch
Lunch

Evening

Dinner

Before
Sleep

14. DO YOU HAVE ANY MEDICAL PROBLEM/INJURY? IF

YES, THEN PLEASE MENTION IN DETAIL.

15. HAVE YOU BEEN USING ANY SUPPLEMENTS, OR

ANABOLIC STEROIDS? PLEASE MENTION IN DETAIL.

16. PLEASE DESCRIBE A DAY’S ACTIVITY IN YOUR

LIFE/HOW DO YOU SPEND YOUR DAY FROM THE TIME YOU
WAKEUP TILL YOU SLEEP.

17. DO YOU HAVE ANY OF THE FOLLOWING HABITS

(Please mention):

- EXCESSIVE SMOKING/TOBACCO
- ALCOHOLISM
 - EATING JUNK (SUGARY, FRIED ETC.)
- DRINKING SUGARY BEVERAGES & SODAS

18. ANY OTHER SPECIFIC ISSUE YOU WANT TO MENTION,

YOU THINK WILL HELP US DESIGN YOUR PROGRAM
BETTER?

19. WHAT DO YOU THINK ARE THE MAJOR

OBSTACLES/BARRIERS IN YOUR FITNESS & DIET PROGRAM?
(For e.g., long working hours, lack of time, improper facility
for exercise, bad diet, sleep issues, stress etc.)

20. WHERE DID YOU FIRST HEAR ABOUT THE GENESIS

PROGRAM?