Name
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First Name
Last Name
Email
*
Phone
(###)
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Age
Gender
Height
Current weight
Desired weight
Known and medically diagnosed health issues
Do you have any special medical recommendations regarding the amount and intensity of your daily physical exercising? If yes, please specify.
Do you exercise? If yes, please specify type of exercise, frequency, intensity, length of one session.
What are your favourite swimming strokes? Freestyle / breaststroke / backstroke / dolphin kick / butterfly / sidestroke / lifesaving backstroke.
How often have you swam over the last three months?
Do you prefer to swim in the ocean or in a pool?
Do you have easy access to a pool? If yes, what size?
If you were to swim at least three times a week, what time of the day would be most suitable for you?
How many meals do you eat every day?
Please describe your usual meals during a normal day, with approximate times for each: breakfast, lunch, dinner, snacks.
What do you drink during a typical day? Please describe types of drinks and approximate quantities (include both alcoholic and non-alcoholic).
Do you smoke? If yes, how much?
Do you cook? If yes, how often? If not too often, what are the reasons preventing you?
What do you consider as the most important factors impacting your weight currently?
What makes losing weight important for you now? What will change for you when you reach your desired weight?
