BASIC INFORMATION - Leigh Peele



Phone Consultation Fill out the document in as much detail as you can.All information is required unless otherwise stated. All information protected for privacy unless it involves medical issues concerning your wellbeing or violations of the law.BASIC INFORMATIONThe purpose of this section is to collect as much information as possible regarding the reason for this phone consultation. Please provide as much detail as you can. I will work with the information you supply, so keep in mind the more I know, the better I can assist you during our call.*Preferred Name:*Gender:*Age:*Location:*Time Zone: *Phone Number:Height:Weight:Body Fat Percentage:Measurements:Neck:Arm:Chest:Waist:Stomach:Hip:Thigh:Calf:PICTURESPictures allow me to see your body composition as best as possible, you do not have to share this. If you have videos of yourself exercising or in movement, for example doing squats, deadlifts, running, or other exercises, please send/link them as well. They are definitely encouraged.NOTE: Do not perform any movement that you can’t execute easily. If you are obese, injured, or out of shape, please do not send pictures showing you performing exercises that are difficult for you. Please use your discretion and judgement. Front: With your full body in frame, keep your arms at your sides, and stand relaxed.Side: With your full body in frame, keep your arms at your sides, and stand relaxed.Back: With your full body in frame, keep your arms at your sides, and stand relaxed.Front: With your full body in frame, flex your arms, and brace your chest and core.Back: With your full body in frame facing away from the camera, flex your arms and back.Front: Position your body in a full squat (or as far as you feel comfortable lowering) with your arms straight out, above your head. Side: Position your body in a full squat (or as far as you feel comfortable lowering) with your arms straight out, above your head. Most Muscular: Might be cheesy, but this pose provides me with some understanding of your muscle amount/definition.Examples Here EXTRA BODY QUESTIONS What kind of body do you see yourself having?Do you have a photographic example of this body? If yes, please include a link or description. Do you have any specific areas where you have proportion issues or dislike of your current body?HEALTH ASSESSMENTHas your doctor ever said you have a heart condition, or that you should only perform physical activity recommended by a doctor?Do you feel pain in your chest when you perform physical activity?In the past month, have you had any chest pain when you were not performing physical activity?Do you lose your balance due to dizziness? Do you ever lose consciousness?Do you have any bone or joint problems that could be made worse by a change in your physical activity?Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?Have you had any bodily pain or injuries (ankle, knee, hip, back, shoulder, etc.)? If yes, please explain.Have you had any surgeries? If yes, please explain.Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol, or diabetes? If yes, please explain.Are you currently taking any medication? If yes, please list.Do you have any food intolerances or allergies?Do you smoke/have you ever smoked? If so, how much per day?Are you currently diagnosed and/or seeking treatment for any mental health issues? Do you know of any reason why you should not engage in physical activity?Are there any other physical or mental ailments you feel I should be aware of? Please know you have complete confidentiality, and this is a no judgment zone.NUTRITIONAL ASSESSMENTList out your normal diet in as much detail as possible. Do not try to paint any pictures and be as forthcoming as possible. There is no bad food; there are no bad answers.How well do you understand the basics of nutrition (calories, macronutrients, minerals, etc)?Do you have any nutritional limitations, allergies, ethics, or phobias which make it difficult for you to eat a balanced diet?Do you have any problem tracking your food intake via the following methods—food journal, eye estimations, scale weight—any of which may be required? The method of tracking food intake is different for every client. There is no “right” method. Depending on your specific goal, sometimes there is a need to take a stricter approach, sometimes a more lax approach. It will depend on your specific goal. Do you have a problem with this?Do you have any special cooking or preparation limitations? Do you need a diet based solely on buying prepared food and not preparing it at home? FINAL QUESTIONSIn detail, give the reason for your phone consultation. The more detail you provide, the more research I can do prior to our call and be prepared. A lot of the greatness to this call depends how much you’re willing to give to this document. So give as much as you can. Please supply any links, research, pictures, videos, or any other items containing pertinent information for your consultation at least 24 hours in advance. Providing these items and allowing me to review them prior to our call will leave more time to clarify the issue(s) and discuss resolutions during the call.If you think there is anything else I need to know or that you want to share before the consultation, please let me know. Please remember there is a time limit for your call. If you realize you need more time than anticipated, please contact support@ to adjust your call time. ................
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