Please complete the DuPage Fit Male survey below: Male - Health & Performance Metrics v3 Personal Information First Name * Last Name * Phone * Email * What is your #1 Goal? * Are you an Athlete? * NoHigh School AthleteCollege AthleteProfessional Athlete Are you an Athlete? Your DuPage Fit Total Fitness Index Your DuPage Fit Life Span Index Your DuPage Fit Health Span Index Your DuPage Fit Aesthetic Index Your DuPage Fit Performance Index Your DuPage Fit Athletes Index DuPage Fit Labs Index Your DuPage Fit Lab Test Index Your HA1C * LDL * Vit D * Triglycerides * Cholesterol * HDL * Trig./ HDL Ratio * DuPage Fit Cardio Index Your DuPage Fit Cardio Index Systolic * Diastolic * 1 Mile Walk/Run * Pulse * PRS Pulse DuPage Fit Aesthetic Index Your DuPage Fit Aesthetic Index Weight * Height in feet * Height (Inches) * Neck Circumference * Shoulders Circumference * Waist Circumference * Hips Circumference * Waist to Hip Ratio DuPage Fit Orthopedic Index Your DuPage Fit Orthopedic Index Push-Ups Greater Than 3534 to 3029 to 2019 to 10Less Than 9 Chair Squat * Plank * 1 Mile Walk/Run Mobility Squat * 6 Point Upper Body Mobility * Please Select a ValueButt contacts the wallButt & shoulder contact the wallButt, shoulder, back of head contact the wallButt, shoulder, back of head & elbows contact the wallButt, shoulder, back of head, elbows & wrists contact the wallButt, shoulder, back of head, elbows, wrists contact the wall and the arms vertically lengthen while maintaining contact with the wall Toe Touch * Chronic Pain Please Select a ValueNo Pain in any jointsIntermitttent pain in a jointConstant Pain in one jointConstant Pain in two jointsConstant Pain in 3 or more joints DuPage Fit Athletes Index Your DuPage Fit Athletes Index Box Vertical Leap * 40 yard Dash * Standing Broad Jump * 5-10-5 Cone Drill * 60 sec Jump Rope * Bench press * Pull-up * Leg Press * 60 sec Sit-ups * Protein Intake (g) * DuPage Fit Life Style Index Your DuPage Fit Life Style Index Age * Exposure to second hand smoke or direct use of tobacco products * Please Select a ValueNoneSocialDaily Use Weekly Alcohol Intake (# of Drinks) * Please Select a ValueO Drinks1 to 7 drinks8 to 14 drinks15 to 21 drinks Lifestyle Activity Pattern (5 -7 days a week) * Please Select a Value10,000-15,000 steps daily7,500-10,000 steps daily5,000 to 7,500 steps daily<5,000 steps Typical amount of weekly exercise * Please Select a Value5-6 Hours4-3 Hours3-2 hoursUnder 2 hours Your DuPage Fit Nutrition Index Your DuPage Fit Daily Nutrition Index Water in cups (note 8 oz = cup) * Please Select a Value12 to 11 servings10 to 9 servings8 to 7 servings6 to 5 servings4 or Less Leafy Green Veggies (cups) * Please Select a Value10 to 8 servings7 to 5 servings4 to 2 servingsLess than 1 serving Solid Colored Veggies or fruits (cups) - Weekly * Please Select a Value6 to 5 servings4 to 3 servings2 servingsLess than 1 serving Beans (not baked beans) cups * Please Select a Value3 servings2 servings1 servingLess than 1 serving Plain Unsalted or Roasted Seeds or Nuts (cups) * Please Select a Value4 servings3 servings2 servingLess than 1 serving Daily Processed Food Servings * Please Select a Value0 servings1 serving2 servings3 or more servings Weekly Seafood and fish servings * Please Select a Value4 Servings or more3 Servings2 Servings7= 1 Serving or less Date If you are human, leave this field blank. Submit
