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Contact Information
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First Name: MI:Last: 
Address Line 1:
Address Line 2:
City: State:Postal Code:
Country: Email:Phone:
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Unit of Measure
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Select the unit of
measure you wish to use for height and weight entries:
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English
(inches, lbs) Metric
(cm, Kg)
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Personal Information
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Sex: Female Male
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Pregnant/Nursing: n/aPregnant Nursing
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Height: inches/cm
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Age:
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Body Frame
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If you don't already
know your body frame type, try this: place your thumb and middle finger
around your wrist. If they overlap, enter "small." If they just
touch, enter "medium." If they don't touch, enter
"large."
Body Frame: Small MediumLarge
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Activity Level
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Check the appropriate
activity level that most closely approximates your lifestyle. Examples:
Sedentary = working behind a PC. Moderately Active = waiting tables. Active =
construction work.
Activity level: SedentaryModerately Active Very
Active
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Body Weight
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Present Weight: lbs/Kg
Desired Weight: lbs/Kg
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Desired loss/gain per week: lbs/Kg
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Body Weight
Charts for Women
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Body Weight
Charts for Men
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Personal Goal - Optional
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This selection is
optional. Please select the option that most closely describes your goal:
Lose Weight Maintain
Weight Gain Weight Increase
Athletic Performance
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Peak Body Weight - Optional
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What is the most you ever weighed?:
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lbs/Kg
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When did you weigh this amount?:
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Comments and Additional Information -
Optional
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Please enter additional
information you feel is important to consider in your personal assessment.
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