Client Goals Questionnaire

Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
PART 1 - Lifestyle Related Questions:
How many hours do you normally sleep a night?
Describe Your Job

SedentaryActivePhysically Demanding
PART 2 - Exercise Related Questions:
How would you describe your current fitness level? Do you know your 1-mile run time? Do you know your MAXs of any exercises? Please include as much as possible.
How often do you take part in physical exercise?

1-2x/week3-4x/week5-7x/week
If your participation is lower than you would like it to be, what are the reasons?
How long have you been consistently physically active for (if applicable)?
Describe your exercise routines for the last 6 months
PART 3 - Nutrition Related Questions:
How would you rate your Nutrition?
How many times a day do you usually eat (including snacks)?
How many glasses of water do you consume daily?
How many calories are you consuming, on a typical day?
Please list all supplements you take:
PART 4 - Goal Setting
Where do you rate health in your life?

Low PriorityMedium PriorityHigh Priority
What are you particular goals for your programming? What is the fitness goal you would like to achieve by the end of your program? (Please be VERY specific)
Are you training for a specific event or goal? Please be detailed on what that event is and when.
How long would you like your training to be?
What days are you available to workout?

SundayMondayTuesdayWednesdayThursdayFridaySaturday
How committed are you to achieving your fitness goals?

VerySemiNot Very
What do you think the most important thing your Coach can do to help you achieve your fitness goals?
Please check all available equipment:

Basic Gym AccessRucksack or bag capable of carrying up to 55lbKettlebellsPull up barTreadmillStationary bikeTrackAreas with incline or hillsPoolSandbagsWater candle
List any other equipment considerations to your training:
Outline what you feel are the obstacles or your potential actions, behaviors or activities that could impede your progress towards accomplishing your goals (i.e. not training consistently, upcoming vacation, busy season at work, not following the program, allowing other responsibilities to become a priority over exercise etc.).
Last Questions...
How did you hear about us? Please check that which applies.

GoogleSocial MediaReferralWebsiteOther
Did anyone refer you?
Do you understand that the payment for this programming is $199 +tax, month to month subscription-based (1st payment due on 1st day of training) and is NOT refundable due to the nature of this service?*

I understand and AGREE to payment terms
Signature*

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PART 1 - Lifestyle Related Questions:

PART 2 - Exercise Related Questions:

PART 3 - Nutrition Related Questions:

PART 4 - Goal Setting

Last Questions...