Two Island Girls Consult Form:
Name *
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I am:
Age:
Height:
Current Weight:
Goal Weight:
Please select your body-type
 Pear shaped - Most of your weight is carried on the hips, buttocks, thighs, and lower waist 
 Apple - Most of your weight is carried in the mid-section (Lower waist up to Chest) 
 Hourglass - Your weight is equally proportioned on the Upper and Lower body. 
 Ruler - Your weight is equally proportioned on the upper, mid-section, and lower body. 

Eating Habits

I eat green and/or colored vegetables
I eat starchy foods - breads, potato, rice, pastas
I eat chicken, turkey, etc
I drink plain water
I drink wine
I drink liquor
I drink coffee
I eat sweet foods - cake, candy, ice cream, etc.
I eat fresh fruits -
I eat seafood - fish, salmon, shrimp, tuna, etc
I eat red meats - steak, beef, etc.
Most of the vegetables I eat are
Most of the fruits I eat are
Most of the meats I eat are

Physical Activity

I consider myself to be in
On a scale of 1-10 with 10 being the greatest, how would you rate your exercise experience.
 1 
 2 
 3 
 4 
 5 
 6 
 7 
 8 
 9 
 10 
When I design your program how many days per week will you be able to exercise
 0 
 1 
 2 
 3 
 4 
 5 
 6 
 7 
On average, how many days per week do you currently exercise
 0 
 1 
 2 
 3 
 4 
 5 
 6 
 7 
On the days you chose above how much time will you have to dedicate to exercise
On average, what time of the day will you be able to exercise
When I achieve my goals you can use me as a Success Story
A different name will be used to protect your identity
 Yes 
 No 
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