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Personal information:
*Full Name:
*Date of Birth:	/ /
*Age:	Female:  Male:
*Height:	0ft 1ft 2ft 3ft 4ft 5ft 6ft 7ft Feet 0in 1in 2in 3in 4in 5in 6in 7in 8in 9in 10in 11in inches
Ethnic background:	Other Native American Caucasian Hispanic Asian and Pacific Islander African American Middle Eastern
*Current Weight:	lbs.
*Goal/Ideal Weight:	lbs.
Chest Measurement:	.inches
Waist Measurement:	.inches
Hips Measurement:	.inches
Wrist (Female Only):	.inches
Forearm (Female Only):	.inches
My goal is...*
Gain Weight	1 lb. a week:   2 lbs. a week:
Lose Weight	1 lb. a week:   2 lbs. a week:
Maintain Weight
Activity level:
Activity Level:	Sedentary - little or no exercise, office job Lightly Active - light exercise/sports 1-3 days/week Moderately Active - moderate exercise/sports 3-5 days/week Very Active - Hard exercise/sports 6-7 days/week Extremely Active - Hard daily exercise/sports & physical job
Fitness Goal:
Fitness Goal:	Heart Healthy Weight Management Cardiovascular Fitness Anaerobic Fitness
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