Perfect Fit Nutrition :: Men Add-on Assessment

PFN Weight Loss Add-On Assessment

Remember, answering this assessment with detailed responses is very important to ensure that the calorie and macronutrient information provided to you best reflects you and your daily lifestyle.

PLEASE SUBMIT ASAP. Your results will come 5-7 days after we receive submission.

*** PLEASE BE SURE TO FILL IN ALL BLANKS BEFORE YOU SUBMIT TO ENSURE THAT THE ASSESSMENT GOES THROUGH.

Name (First and Last)

What is the name of your significant other who is a member of PFN?

Birthday

Age

Gender

Height

Weight

Goal Weight

Current Daily Activity (please be as detailed as possible regarding activities, exercise regimen and length of time)

Please list any barriers or successes in weight loss and/or fitness

Please list any medical conditions or regular medications.

List a food/food group you have learned you cannot live without.

What is your “why” for joining this program? Be detailed and specific.

Agreement Agreement By completing this questionnaire, you agree that you have received permission from your doctor prior to signing up. You also agree that the information provided to you is not an individual prescription, but is education intended to enhance your knowledge of health as it relates to nutrition and physical activity. You understand that the wellness information received will not take medications, food allergies, or other illnesses into consideration and that you are responsible for the management of such. Perfect Fit Nutrition will not be held responsible for any injury or illness that may occur during or after this membership term.

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