Middle Initial :
Email Report To:
Unit of Measure
Select the unit of measure you wish to use for the
height and weight entries:
English (inches, lbs)
Metric (cm, Kg)
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.”
Check the appropriate activity level that closely approximates lifestyle.Examples: Sedentary = working behind a PC. Moderately Active = waiting tables. Active = construction work.
Present Weight (lbs/Kg):
Desired Weight (lbs/Kg):
Desired loss/gain per week (lbs/Kg):
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.5 3.0
Body Weight Charts for Women
Body Weight Charts for Men
Resting Heart Rate
Please enter your heart rate, measured first thing in the morning before you get out of bed.
Percentage Body Fat Composition Values
Present Body Fat %:
Desired Body Fat %:
Please enter both values if you want calculations to be based on
your body fat content.
Body fat calculations will override any value you may
have entered for Desired Weight.
Body Fat Chart for Women and Men
Exercise Calorie Activity
Exercise Activity Intensity
Daily Exercise Calorie Expenditure Goals
Exercise Calorie Goal – Monday:
Exercise Calorie Goal – Tuesday:
Exercise Calorie Goal – Wednesday:
Exercise Calorie Goal – Thursday:
Exercise Calorie Goal – Friday:
Exercise Calorie Goal – Saturday:
Exercise Calorie Goal – Sunday:
Exercise Calorie Expenditures Sorted by Activity
PCF Ratio Goal
If you aren’t sure what ratio should be, leave them blank…
our Nutrition Coaches will recommend one for you. Enter your goal for these three variables as a percentage of
your total daily calorie intake: % Protein Calories:
% Carbohydrate Calories
% Fat Calories:
(These three percentages must equal 100%.
If they don’t, we’ll enter values for you.)
Increase Athletic Performance
Peak Body Weight
Most you ever weighed?:
When did you weigh this?:
This is my present weight. Within the past three months. Within the past six months. Within the past 12 months. Within the past two years. Within the past five years. More than five years ago.
Please select as many as apply:
Gastric Reflux Hypertension
Irritable Bowel Syndrome
Comments and Additional Information
Please enter additional information you feel is important to consider in your personal assessment.