My Body Shape
Please Enter the Following Information:

Email Address:
First Name:		Last Name:

1.  Age
2.  Sex	Male  Female
3.  Body Build	Ectomorph Endomorph Mesomorph Combination Of AND
4.  Height	Short    Medium    Tall
5. Weight	Too Light    Too Heavy    Ideal    Plump
6. Calculate     your BMI:	Your Weight (   ) divided by Height (   )  =
7. I Wish I     Were	Lighter    Heavier    The Same
8. How Do I Feel About The Way I Look?
9. In Five Years How Do I Want To Look?
10.  Am I Trying To Change The Way I Look?    Yes  No
11. If Yes, How?   (to question #10)
12. My Favorite Way To Exercise Is:
13. I Exercise    Times Per Week.
14. I Have Enough Coordination And Strength To Do And Enjoy Things   Yes  No
15. Am I Sick A Lot?   Yes  No
16. My Body Condition Is	Excellent    Good    Poor
17. I Would Like To Take Better Care Of My Body By:

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