Client Questionnaire

If you are new to The 5 Day Plan and have not yet completed a client questionnaire, please do so below before ordering so we can make sure your expereicnce is tailored to you.

All answers are kept confidential and we are GDPR compliant. Please view our privacy policy or email us if you have any questions regarding this.

 

Your name 
*
Sex 
*
Age 
*
Date Of Birth 
*
Phone Number 
*
Email 
*
Home Address 
*
Occupation 
*
Your Height (cm) 
*
Your Weight (kg) 
*
Where is the best place to leave your package each evening? Deliveries are made between 7- 10pm. Please include any door codes or helpful instructions/directions? If you ask us to leave your package in an unsecure place, once delivery is made, it is not our responsibility. 
*
Dietary Requirements
How often do you train? Please specify the type of training
What are your goals?
Are you currently taking any medication and/or supplements? If yes, what?
How are your energy levels? 
*
Low
High
How are your bowel movements? 
*
Poor
Good
How is your skin? 
*
Poor
Good
How is your sleep? 
*
Poor
Good
How is your concentration? 
*
Poor
Good
How is your mood? 
*
Poor
Good
Submit
Thank you for completing the client questionnaire!
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