Fitness Assessment Questionnaire

Fitness Assessment Questionnaire
Please answer all questions accurately and honestly to allow us to fully determine your individual needs.
Date*

MonthDayYear
Date
Name*

First NameLast Name
Birthday *
mm/dd
Phone*
Format: (000) 000-0000.
Email*
example@example.com
Address*
City*
State*
Zip*
Age*
Height
Current Weight
Ideal Weight *
YESNO
YESNO
YESNO
YESNO
YESNO
How long did you keep your last heath club membership while not using the facility?*
How often do you eat out?*
Please list the habits you would most like to change?*
What events in your life are coming up that will motivate you to reach your goal?*
After 1 year from now you and I are celebrating your success, what does it look like to you?*
1-56-1011-1516-20
TimeMoneyNo facilityProcrastinationLack of supplementsOther
In your own opinion, why did you fail to “stick with it”?*
Lose weightGain weightFeel betterLook betterLive healthier
15. On a scale of 1-10, how serious are you about achieving your fitness goals?*
Is there any injuries your trainer should be aware of?*
If none, enter N/A
Release and Waiver of Liability
Kev Fit, Inc. client hereby agrees to hold harmless indemnify Kev Fit, Inc. its offers and employees for any bodily injury, accident, or property damage arising out of the equipment, training, or facilities. Client warrants that he/she has no disabilities preventing him/her from utilizing Kev Fit, Inc. fitness services.
Print Name*
Signature*
Date*

MonthDayYear
Date

Release and Waiver of Liability