Distance Coaching Warning: count(): Parameter must be an array or an object that implements Countable in /home/customer/www/imagen-fit.com/public_html/wp-content/plugins/gravityforms/includes/fields/class-gf-field-list.php on line 685 Paso 1 de 9 11% INITIAL EVALUATION WELCOME! The information provided will be handled CONFIDENTIALLY in order to obtain the necessary data to provide a fully customized program. Instructions: Answer the following questionnaire, If you provide more data and resources, we will design your plan better. The plan is monthly until you achieve your goals. You will have to submit a copy of your deposit when you return the questionnaire to start making your plan that takes 3 business days to arrive. Bank Account to make the deposit: Bank: Bancomer To Name: Diana Gabriela Perez Rosas Account: 1100993441 Clabe Account: 012180011009934414 Swift: BCMRMXMM Proof of payment*Tipos de archivos aceptados: jpg, png, pdf.Attach your proof of payment. Can be jpg, png or pdf with maximum file size of 10 MB. Personal information:Full Name* Name(s) Last Name Birthdate:*Día12345678910111213141516171819202122232425262728293031Mes123456789101112Año202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age:*Gender:*MaleFemaleCivil status:*SingleMarriedOccupation:*StudentHousewifeEmployeeEntrepreneurBusinessman/BusinesswomanAddress:* City Estate ZIP Code AfghanistánAlbaniaArgeliaSamoa AmericanaAndorraAngolaAntigua y BarbudaArgentinaArmeniaAustraliaAustriaAzerbaiyánBahamasBaréinBangladeshBarbadosBielorusiaBégicaBeliceBeninBermudaBhutánBoliviaBosnia y HerzegovinaBotswanaBrasilBruneiBulgariaBurkina FasoBurundiCamboyaCamerúnCanadaCabo VerdeIslas CaimánRepública CentroafricanaChadChileChinaColombiaComorasCongo, República Democrática delCongo, República deCosta RicaCosta de MarfilCroaciaCubaCurazaoChipreRepública ChecaDinamarcaDjiboutiDominicaRepública DominicanaTimor OrientalEcuadorEgiptoEl SalvadorGuinea EcuatorialEritreaEstoniaEtiopíaIslas FaroeFijiFinlanciaFranciaPolinesia FrancesaGabónGambiaGeorgiaAlemaniaGhanaGreciaGroenlandiaGranadaGuamGuatemalaGuineaGuinea BissauGuayanaHaitíHondurasHong KongHungríaIslandiaIndiaIndonesiaIránIraqIrlandaIsraelItaliaJamaicaJapónJordánKazajistánKeniaKiribatiCorea del NorteCorea del SurKosovoKuwaitKirguistánLaosLituaniaLíbanoLesotoLiberiaLIbiaLiechtensteinLituaniaLuxemburgoMacedoniaMadagascarMalawiMalasiaMaldivasMaliMaltaIslas MarshallMauritaniaMauricioMéjicoMicronesiaMoldaviaMonacoMongoliaMontenegroMarruecosMozambiqueMyanmarNamibiaNauruNepalPaises BajosNueva ZelandaNicaraguaNígerNigeriaIslas Marianas del NorteNoruegaOmánPakistánPalauPalestina, Estado dePanamáPapúa Nueva GuineaParaguayPerúFilipinasPoloniaPortugalPuerto RicoQatarRumaníaRusiaRuandaSan Cristóbal y NievesSanta LucíaSan Vicente y las GranadinasSamoaSan MarinoSanto Tomé y PrincipeArabia SauditaSenegalSerbiaSeychellesSierra LeonaSingapurSint MaartenEslovaquiaEsloveniaIslas SalomónSomaliaSudáfricaEspañaSri LankaSudánSudán del SurSurinamSwazilandiaSueciaSuizaSiriaTaiwanTayikistánTanzaniaTailandiaTogoTongaTrinidad y TobagoTúnezTurquíaTurkmenistánTuvaluUgandaUcraniaEmiratos Árabes UnidosReino UnidoEstados UnidosUruguayUzbekistánVanuatuCiudad del VaticanoVenezuelaVietnamIslas Vírgenes BritánicasIslas Vírgenes de los Estados UnidosYemenZambiaZimbaue Country The city where it is located to know the availability of foodPhone:*Email:* Enter email Confirm email Personal InformationWith who you live?*ParentsMate and/or kidsSingleDo you have kids?*YesNoHow many? and What ages they have?Approximately How many hours do you work or study per day?*< 44 - 8> 8How is your job?*ActiveDesktopApproximately How many hours do you sleep a day?< 66 - 8> 8Does your partner, your parents or who you live support your decision to get fit?*YesNo Anthropometric Information:Height:*Actual weight (fasting and without clothes):*Greater weight reached:*Lowest weight reached:*Arms (triceps height):*Measures in cm:Bust (height of nipples):*Measures in cm.Waist (navel height):*Measures in cm.Hip (half gluteus height):*Measures in cm.Thighs (height ):*Measures in cm.Size of clothing (26, 28, 30, etc.):*Measures in cm. Medical Information:With this information can prevent diseases through diet and supplementation.Do you take any medication?*YesNoWhich? Why?*Overweight and obesity:* Father Mother Paternal grandparents Maternal grandparents None Diabetes:* Father Mother Paternal grandparents Maternal grandparents None Hypertension:* Father Mother Paternal grandparents Maternal grandparents None Cardiovascular diseases (heart attacks, arrhythmias);* Father Mother Paternal grandparents Maternal grandparents None Cancer:* Father Mother Paternal grandparents Maternal grandparents None ¿Type?High cholesterol levels:* Father Mother Paternal grandparents Maternal grandparents None High levels of triglycerides:* Father Mother Paternal grandparents Maternal grandparents None Arthritis:* Father Mother Paternal grandparents Maternal grandparents None Have you used any medication to increase muscle mass or lose fat such as steroids, hormones, amphetamines?*YesNoMention brands, time of use, milligrams, who recommended and aesthetic effects achieved after employment.What injuries have you had in the last 5 years? Was it treated correctly by a specialist?*What diseases have you had in the last 5 years?*What surgeries have you had throughout your life? (Aesthetic and non-aesthetic)*Mention the times when you have been hospitalize*What medications are you currently taking? and how long have you been taking them?*Do you smoke or have you smoked? Describe*Do you drink alcohol? Describe what type of alcohol you drink and what amount approximated a week.*In what activities do you use your free time?*Have you had any problem of drug addiction or alcoholism? Please describe.*Have you ever been diagnosed with an eating disorder?*YesNoHave you sense that you have a food disorder?*YesNo Eating habits:Description of what normally comes. Includes quantities, drinks, sweets, snacks and supplements.Day 1. Ordinary day:*Day 2. Extra day like weekends:*How many meals do you make per day?*1 - 23> 3FOOD PREFERENCES*Healthy foods that displease meHealthy foods that I like If you are taking any food supplement, what is it?* If you want to use supplements, how much money could you spend monthly?*Do you tend to eat more or eat less when you are under pressure or stress?*YesNoWhat foods are you allergic to?* How many liters of water do you currently take on average?*Next, there's a list of foods, mark those that YOU CAN'T be consumed:* Strawberries (frozen or fresh) Red Fruits (raspberries, blackberries, etc.) (frozen or fresh) Grapefruit Kiwi Melon Mango Papaya Pineapple Apple Banana Raisins Beans Spinach Avocado Celery Alfalfa Pumpkin Cucumber Broccoli Carrot Peppers (red, yellow and green) Asparagus Mushroom Cauliflower Lettuce Onion Tomato Sweet potato Potato Integral rice Oats Nopal tortillas Wheat pasta Wholemeal bread Rice cakes Chicken Beef Turkey (NOT turkey ham) Salmon Fish (Nile white) Surimi Egg whites Tofu Cottage cheese Powdered protein Milk Light Yogurt light Almonds Nuts (mixed) Peanuts Pistaches Peanut butter PAM (spray oil) Olive oil Oil (flaxseed, sunflower, etc.) If there is not a food item on the list that you eat regularly, please write it down. What kind of food do you crave the most (sweet or salty) and which ones?*SweetSaltyWhat time of day is there the greatest anxiety to eat?*MorningAfternoonEvening Habits of Physical Exercise:Do you currently perform physical activity?*YesNoWhich?GymRunSwimmingSports teamHow is your current training? Days and times a week. If you train with weights, briefly describe your weekly routine.*How long have you been doing this activity?*Schedule in which you exercise, in case of not doing and wanting to do under my advice, indicate the schedule in which you will perform this activity:*MorningAfternoonEveningWhere do you exercise?*HouseGymParkWith what equipment does the place where you exercise count?*Free weightsMachinesDo you have equipment to perform cardiovascular training?*YesNoDescribe how your activities are in the week and the weekend:* BASIC INFORMATION FOR IMAGEN FITWhat is your main objective with the program?*Build muscle (gain some weight)Losing weight (reduce my size and harden)Change the composition of my body (maintain my weight and harden)What do you consider your problem areas? Or what parts of your body do you think need more attention / work?*ArmsChestBackAbsButtocksLegsCalvesHow many times a week (being realistic) do you think you can go to the gym in a week?*12 - 34 - 56How much time do you spend in each session?*1 hour1 to 2 hoursThe time that is necessaryDescribe what you think you should emphasize* Perseverance Intensity Motivation Other Have you tried before to get fit? What has failed?*What "look" would you like to achieve? How is your ideal body? Describe*Add to this document a photo of someone who approaches your ideal physique. (an actor, model, competitor) INDISPENSABLE.*Tipos de archivos aceptados: jpg, png, gif.What are you waiting for YOURSELF in this occasion?*What do you consider your main motivation to achieve the best form of your life?*Any additional comments before we start?* File photos: (Only views by me.)Please, take your photos in Swimsuit (not in underwear) 3 photos: one of front, one of back, and one profile (whichever it is) with the feet together and hands to the sides and attach them to this file in JPG format.Front:*Tipos de archivos aceptados: jpg, png, gif.Back:*Tipos de archivos aceptados: jpg, png, gif.Side face:*Tipos de archivos aceptados: jpg, png, gif.It is INDISPENSABLE that you send your photos to be able to give a program according to your needs and to document your progress. Δ