BODY BY DAVEY T - Application Form

Must completely fill out all the fields below.

(Leave Yes un-checked if your answer is no.)

Your Name
Your Email Address
Your Mailing Address
Your Age
Your Sex
Your Height
Your Weight
What is your workout history?
Please explain your health and injury history in detail.
What is your favorite type of physical activity?

How many days a week will you work out?

(Your program will be designed for this number of days.)

How many meals per day do you eat?
What is your average daily caloric intake?
What are your 3 favorite meats?
Are you willing to drink 1 protein shake daily?
What are your 4 favorite fruits?
What are your 4 favorite vegetables?

What are your 4 favorite complex carbohydrate sources?

(breads, oats, rice, starches, grains, etc)

Do you have access to a gym or exercise equipment?

If so, please explain.

Do you like to run, walk, cycle, or play any kind of sport?

If so, please explain.

Do you listen to music during your workout?
Do you watch television during your workout?

Have you ever been a diet? If so please explain.

Did you accomplish your goal?

Do you feel good about your physical appearance?
Do you suffer from depression or anxiety?

On a scale of 1-10 (1 being the lowest & 10 being the highest)

where would you rate your stress levels?


Do you drink Alcohol? If so how many drinks daily?
Do you smoke or use Tobacco products? If so please explain.
Do you believe you can acheive your health and fitness goals?
Are you excited about your new lifestyle and Body By Davey T?

* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Research suggests that these programs are safer when used without the intake of additional caffeine or metabolic drugs in the diet.

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