Step 1 of 6 – About You

• Your Information

• First Name*
• Last Name*
• Email Address*
• Phone*
• Gender*Select One…MaleFemale
• Occupation*
• Age*
• What is your Height? (In feet)*
• What do you Weigh? (In pounds)*

• Your Current Fitness

• How often do you exercise?*Select One1 – 2 days a week3 – 4 days a week6 days a week0 days a week and ready to start
• What does your exercise consist of? Select all that apply.*
  • Walking
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  • Running or Jogging
  • Cycling
  • Lifting Weights at the Gym
  • Lifting Weights at Home
  • Going to Bootcamps
  • Yoga
  • Pilates
  • Cardio
  • Playing a Sport Occasionally
• What kind of exercise equipment do you have at home? Check all that apply.*
  • Exercise Bands
  • Treadmill
  • Dumbbells
  • Barbells
  • Pull Up Bar
  • Exercise Bike
  • Eliptical Machine
  • I have no exercise equipment
• Do you belong to a local gym?*Select OneNoYes
• What Gym do you belong to?*
• Do you have any injuries or health conditions that prevent you from vigorous exercise, cardio or lifting weights or bands.*Select One…NoYes
• Please explain any injuries or conditions*

• Your Current Nutrition

• What time is your first meal of the day?*
• What time is your last meal of the day?*
• What do you typically eat for breakfast? (Please be detailed, honest and very specific. Include everything)*
• What do you typically eat for Lunch? (Please be detailed, honest and very specific. Include everything)*
• What do you typically eat for Dinner? (Please be detailed, honest and very specific. Include everything)*
• What do you typically eat for Snacks? (Please be detailed, honest and very specific. Include everything)*
• Please list your absolute favorite foods? (Please be detailed, honest and very specific. Include everything)*
• Please list any and all foods you are allergic to (Please list everything)*

• Your Current Conditons

• What time do you wake up for the day?*
• What time do you go to bed for the day?*
• Do you drink alcoholic beverages?*YesNo
• How often do you drink?*Select One…Everyday1 – 2 times a week3 – 4 times a week5 – 6 times a week
• Do you smoke?*YesNo
• How often do you smoke?*Select One…1 – 2 times a week3 – 4 times a week5 – 6 times a weekEveryday – Multiple times per day.Only when I socialize few times per month
• Do you like to Read or Listen to Audiobooks?*Select One…I read occasionallyI listen to audiobooks occasionallyI read regularlyI listen to audiobooks regularlyI rarely read or listen to audiobooks

• Your Fitness Transformation Goal

• What makes you an ideal candidate for a physical transformation?*
• What would you like to accomplish in the area of your fitness? Please tell me your exact fitness goal. Please be very specific. (Ex. I would like to build lean muscle, lose fat and be ripped, or I would like to shed 20 pounds and keep it off)*
• Why is it important to you that you accomplish your fitness goal?*
• Why else is it important to you that you accomplish your fitness goal?*
• Can you think of any other reason why it is important to you that you accomplish your fitness goal?*
• On a scale of 1 – 10, with 1 being the lowest level of desire and 10 being the highest, How determined are you to accomplish your fitness goal?*Select One…10 plus1098654321

• Why do you believe I can help?

• Why do you want me to coach you to your fitness goal? (Ex. I am looking for motivation and accountability, I want a total transformation, etc..)*
• Why should I work with you on your transformation? What characteristics make you the ideal person to take on a program like this and see your goal to its achievement?*
• Is there anything else you would like me to know?

• Acknowledgement and Release

• Terms of Service*

  We make every effort to ensure that we accurately represent these products and services and their potential for results. There is no guarantee that you will experience the same results and by submitting this questionnaire, you acknowledge and accept the risk that the muscle building results, fitness results, competition results and fat loss results differ by individual.

  We make no guarantees concerning the level of success you may experience, and you accept the risk that results will differ for each individual. The testimonials and examples provided are exceptional results, which do not apply to the average purchaser, and are not intended to represent or guarantee that anyone will achieve the same or similar results.

  Each individual’s health, fitness, and nutrition success depends on his or her background, dedication, desire, and motivation. As with any health-related program or service, your results may vary, and will be based on many variables, including but not limited to, your individual capacity, life experience, unique health and genetic profile, starting point, expertise, and level of commitment.

  There is no assurance that examples of past fitness, competition, muscle building and/or fat burning results can be duplicated in the future. We cannot guarantee your future results and/or success. Nor can we guarantee that you maintain the results you experience if you do not continue following the program. We are not responsible for your actions.

  The use of our information, programs, products and services should be based on your own due diligence and you agree that our company is not liable for any success or failure of your physique that is directly or indirectly related to the purchase and use of our information, products and services.

  We present real-world experiences and insights on other people’s experiences for purposes of illustration only.
  The testimonials, examples, and photos used are of actual clients and results they personally achieved. Each client has approved these testimonials, examples, and photos for use in materials to speak to our program, service, and/or product capabilities, but they are not intended to represent or guarantee that current or future clients will achieve the same or similar results. Rather, these client stories represent what is possible with our programs, services, and/or products. I Clifton am not a doctor. The information I provide is based on my personal experience, studies of health and nutrition and my experience as a Physical fitness advisor.
  The information contained in our website, blog, guest blogs, e-mails, programs, services and/or products is for educational and informational purposes only, and is made available to you as self-help tools for your own use. While we draw on our prior professional expertise and background in many areas, you acknowledge that we are supporting you in our roles exclusively as fitness coaches only. We provide information concerning, but not limited to, physical fitness, nutrition and mindset.

  We are not medical health practitioners or mental health providers and we are not holding ourselves out to be in any capacity. Rather, we serve as coaches, mentors and guides who help you reach your own health and wellness goals.

  We aim to accurately represent the information provided on this website, blog, e-mails, programs, services, and products. You are acknowledging that you are participating voluntarily in using our website or blog or in any of our e-mails, programs, services, and/or products, and you alone are solely and personally responsible for your results. You acknowledge that you take full responsibility for your health, life and well-being, as well as the health, lives and well-being of your family and children (born and unborn, as applicable), and all decisions now or in the future.

  In the event that you use the information provided through our website, blog, e-mails, programs, services, and/or products, we assume no responsibility.

  Every effort is made to ensure the accuracy of published information on or through our website, blog, e-mails, programs, services and products; however, the information may inadvertently contain inaccuracies or typographical errors. Every effort has been made to present you with the most accurate, up-to-date information, but because the nature of physical fitness research is constantly evolving, we cannot be held responsible for the accuracy of our content.

  Clifton Mbanugo and Fitness By Clifton strongly recommends that you consult with your physician before beginning any exercise program. You should be in good physical condition and be able to participate in the exercise. Clifton Mbanugo and Fitness By Clifton is not a licensed medical care provider and represents that it has no expertise in diagnosing, examining, or treating medical conditions of any kind, or in determining the effect of any specific exercise on a medical condition.

  You should understand that when participating in any exercise or exercise program, there is the possibility of physical injury. If you engage in this exercise or exercise program, you agree that you do so at your own risk, are voluntarily participating in these activities, assume all risk of injury to yourself, and agree to release and discharge Clifton Mbanugo and Fitness By Clifton from any and all claims or causes of action, known or unknown, arising out of Clifton Mbanugo and Fitness By Clifton

  The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read on this website. Never rely on information on this website in place of seeking professional medical advice.

  Clifton Mbanugo and Fitness By Clifton (fitnessbyclifton.com) is not responsible or liable for any advice, course of treatment, diagnosis or any other information, services or products that you obtain through this site. You are encouraged to consult with your doctor with regard to this information contained on or through this website. After reading articles, watching videos or reading other content from this website, you are encouraged to review the information carefully with your professional healthcare provider.

  • I agree to the Terms of Service
• Please Sign Your Name*

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