Training Questionnaire

Full Name

First NameLast Name
Gender

Other
Date of Birth

MonthDayYear
Age
years
Height
cm
Weight
KG
What are your goals focused around?
Do you have a goal date in mind?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Please rate your readiness for change.

	1	2	3	4	5

1 is Not very, 5 is Very

Are you currently excersising regulary (at least 3x per week)?
If yes, what kind of training are you doing? What is your current training day split? When do you usually train? Be specific and as detailed as you can.
Please list the physical activities that you participate in:
If known, what is your current daily step average?
What kind of training interests you?
Are you experiencing any stresses or issues with motivation?
How often are you willing to train a week to reach your goal? How long can you spend in the gym total including warm-up/cool-down?
What have you tried in the past to get moving on your goals?
What has prevented you from reaching those goals in the past?
What do you do for a living?
Whats the activity level at your job?
Do you follow a regular working schedule? Do you work days, afternoon or nights?
Are you a current cigarette smoker?
Do you drink alcohol regularly?
If you have any diagnosed health problems, please list the condition(s) along with any therapies or medications being undertaken:
If you have any injuries, please list them along with any therapies or medications being undertaken:
Your current diet could be best characterized as:
Wellness Indicators

This part of the questionnaire will be incorporated in periodic check-ins.

How do you feel physically?

	1	2	3	4	5

1 is Worst, 5 is Best

How do you feel mentally/emotionally?

	1	2	3	4	5

1 is Worst, 5 is Best

How well are you sleeping?

	1	2	3	4	5

1 is Worst, 5 is Best

How are your current energy levels?

	1	2	3	4	5

1 is Worst, 5 is Best

Wellness Indicators