Name
*
First Name
Last Name
Email
*
GENDER
MALE
FEMALE
INTERSEX
NON-BINARY
NOT LISTED
HEIGHT
*
WEIGHT
WHAT ARE YOUR FITNESS GOAL?
*
SELECT ALL THAT APPLY
OF THOSE FEW GOALS, WHICH IS YOU PRIMARY GOAL?
*
SELECT ONE
LOSE WEIGHT
GAIIN LEAN MUSCLE MASS
GET TONED AND DEFINED
IMPROVE CARDIOVASCULAR FITNESS
INCREASE FLEXIBILITY
PREPARE FOR LIFE OR ATHLETIC EVENT
RECOVER FROM INJURY
LEARN NEW MOVEMENT OR TOOL
INCREASE OVERALL HEALTH
WHY IS THIS IMPORTANT TO YOU NOW?
*
REALISITICALLY, HOW SOON WOULD YOU LIKE OT ACHIEVE THIS GOAL?
*
SELECT TIME
LESS THAN 1 MONTH
1-3 MONTHS
4-6 MONTHS
7-12 MONTHS
HOW MANY DAYS A WEEK ARE YOU WILLING TO COMMIT TOWARD ACHIEVING YOUR GOAL?
*
SELECT ONE
1 DAY
2-3 DAYS
3-4 DAYS
5+ DAYS
WHAT OBSTACLES DO YOU SEE GETTING IN THE WAY OF ACHIEVING YOUR GOAL?
*
HOW WILL YOU FEEL ONCE YOU ACHIEVE YOUR GOALS?
*
HOW WOULD YOU RATE YOUR EXERCISE EXPERIENCE:
*
SELECT ONE
NOVICE
INTERMEDIATE
ADVANCED
HAVE YOU EVER WORKED WITH A COACH?
*
SELECT ONE
YES
NO
HOW LONG HAS EXERCISE BEEN A PART OF YOUR LIFESTYLE?
*
SELECT ONE
NEW TO EXERCISE
LESS THAN ONE MONTH
1-6 MONTHS
6+ MONTHS
ON AVERAGE, HOW MANY DAYS A WEEK HAVE YOU EXERCISED IN THE LAST MONTH?
*
SELECT ONE
NO EXERCISE
1-2 DAYS
3-4 DAYS
5+ DAYS
WHAT TYPES OF EXERCISE DO YOU ENGAGE IN OVER THE COURSE OF A WEEK?
*
DO YOU HAVE ANY EXERCISE TYPE YOU ARE INTERESTED IN LEARNING?
*
WALK ME THROUGH YOUR DAY
*
NUTRITION, SLEEP, & STRESS
*
I PRIORITIZE MY NUTRITION AND I AM CONTINUALLY SATISFIED WITH MY FOOD
I ACHIEVE GREAT QUALITY AND QUANTITY OF SLEEP DAILY
THE DAILY STRESS I ENDURE DOES NOT AFFECT MY QUALITY OF LIFE
WITH REGARD TO NUTRITION, SLEEP AND STRESS, WHICH DO YOU BELIEVE NEEDS PRIORITIZATION TO ACHIEVE YOUR GOALS?
*
SELECT ONE
NUTRITION
SLEEP
STRESS
HAVE YOU RECENTLY, OR ARE YOU CURRENTLY EXPERIENCING ANY OF THE FOLLOWING?
*
HAVE YOU BEEN DIAGNOSED WITH A SPECIFIC MEDICAL CONDITION?
*
DO YOU HAVE ANY CURRENT OR PAST INJURIES OR HAVE YOU HAD ANY SURGERIES WHICH MAY BE RELEVANT TO PHYSICAL ACTIVITY?
*
SELECT
YES
NO
ARE YOU CURRENTLY TAKING ANY PRESCRIPTIONS OR OVER THE COUNTER MEDICATIONS?
*
SELECT
YES
NO
DO YOU KNOW OF ANY REASON WHY YOU SHOULDN'T DO PHYSICAL ACTIVITY?
*
YES
NO
