2. Workout Readiness Form

1
First and Last Name* This field is required.
First Name
Last Name
2
Your Email Address* This field is required.(Yes yes. We know. We already asked for it. This just helps us confirm it's really you.)
example@example.com
3
Have you ever participated in a diet and/or nutrition program or worked out consistently?* This field is required.
YESNO
4
Did you achieve your goal(s)?
YESNO
5
Did you maintain your goal(s)?
YESNO
6
Have you ever had a personal trainer before?* This field is required.
YESNO
7
What did you like most about working with them?
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Ok
8
What did you like least about working with them?
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Ok
9
Have you ever had any bad experience with a physical activity?* This field is required.
YESNO
10
Please explain:(i.e. Why did/do you hate it?)
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Ok
11
Are you currently exercising regularly (at least 3x per week)?* This field is required.
YESNO
12
Please rate your exercise intensity level on a scale of 1 – 5:* This field is required.(How hard do you push yourself during workouts. 1 minimal intensity to 5 the most intense)
1 - I don't break a sweat (on purpose)
2 - Jogging while reading my favorite book
3 - Yoga + Zumba (but only on the weekends)
4 - No pain. No gain.
5 - Hulk out (no roids tho)
13
Please rate your readiness for change:* This field is required.i.e. How motivated are you?
1 - Not at all ready.
2
3 - I know I need to workout but don't.
4
5 - 100% Committed! I NEED to change.
14
Please rate the following goals from 1 (least important) to 5 (most important):* This field is required.
1 (Least)
2
3
4
5 (Most)
Improve cardiovascular fitness
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Row 0, Column 3
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Body-fat weight loss
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Reshape or tone my body
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Build more muscle
Row 3, Column 0
Row 3, Column 1
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Row 3, Column 3
Row 3, Column 4
Improve flexibility
Row 4, Column 0
Row 4, Column 1
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Row 4, Column 3
Row 4, Column 4
Increase strength
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Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Increase energy level
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Improve performance for a specific sport
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Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Improve mood and ability to cope with stress
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Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Feel better/improved health
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Enjoyment
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Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Improve cardiovascular fitness
Body-fat weight loss
Reshape or tone my body
Build more muscle
Improve flexibility
Increase strength
Increase energy level
Improve performance for a specific sport
Improve mood and ability to cope with stress
Feel better/improved health
Enjoyment
1 (Least)
Row 0, Column 0
2
Row 0, Column 1
3
Row 0, Column 2
4
Row 0, Column 3
5 (Most)
Row 0, Column 4
1 (Least)
Row 1, Column 0
2
Row 1, Column 1
3
Row 1, Column 2
4
Row 1, Column 3
5 (Most)
Row 1, Column 4
1 (Least)
Row 2, Column 0
2
Row 2, Column 1
3
Row 2, Column 2
4
Row 2, Column 3
5 (Most)
Row 2, Column 4
1 (Least)
Row 3, Column 0
2
Row 3, Column 1
3
Row 3, Column 2
4
Row 3, Column 3
5 (Most)
Row 3, Column 4
1 (Least)
Row 4, Column 0
2
Row 4, Column 1
3
Row 4, Column 2
4
Row 4, Column 3
5 (Most)
Row 4, Column 4
1 (Least)
Row 5, Column 0
2
Row 5, Column 1
3
Row 5, Column 2
4
Row 5, Column 3
5 (Most)
Row 5, Column 4
1 (Least)
Row 6, Column 0
2
Row 6, Column 1
3
Row 6, Column 2
4
Row 6, Column 3
5 (Most)
Row 6, Column 4
1 (Least)
Row 7, Column 0
2
Row 7, Column 1
3
Row 7, Column 2
4
Row 7, Column 3
5 (Most)
Row 7, Column 4
1 (Least)
Row 8, Column 0
2
Row 8, Column 1
3
Row 8, Column 2
4
Row 8, Column 3
5 (Most)
Row 8, Column 4
1 (Least)
Row 9, Column 0
2
Row 9, Column 1
3
Row 9, Column 2
4
Row 9, Column 3
5 (Most)
Row 9, Column 4
1 (Least)
Row 10, Column 0
2
Row 10, Column 1
3
Row 10, Column 2
4
Row 10, Column 3
5 (Most)
Row 10, Column 4
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15
Timeline for achieving your goal:* This field is required.
6 Weeks
12 Weeks
18 Weeks
24 Weeks
30 Weeks
1 Year or more
16
How many times are you willing to train per week?* This field is required.
1
2
3
4+
17
At what times during the day would you prefer to train?* This field is required.
Crack of Dawn (before sun up)
Normal Waking Hours (8am - 10am)
College Kid (11am - 1pm)
Hangover Hours (2pm - 4pm)
Dinner Time (5pm - 7pm)
Kids Bedtime (8pm - 10pm)
18
Please list any equipment you own:* This field is required.(e.g. Dumbbells, bands, bench, etc.)
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Ok
Ok
Should be Empty: