You can always press Enter⏎ to continue
PureGym Member Survey
7
Questions
START
1
Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Email
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
3
Phone Number
*
This field is required.
Please enter a valiphone number.
Previous
Next
Submit
Press
Enter
4
What are your hobbies and interests?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
5
What are your goals?
*
This field is required.
You can list as many as you like!
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
6
Please complete the below
*
This field is required.
Strongly Disagree
Disagree
Neither disagree or agree
Agree
Strongly Agree
I have successfully achieve my goals in the past
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
I have a current goal I'm struggling to achieve
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
I'm motivated to achieve my current goals
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
I find things get in the way of my goals easily
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
I'm following a tailored program specific to me to reach my goals
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
I need someone to help with accountability, motivation and support
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
I would benefit from having a personal trainer or online coach to achieve my goals
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
I have successfully achieve my goals in the past
I have a current goal I'm struggling to achieve
I'm motivated to achieve my current goals
I find things get in the way of my goals easily
I'm following a tailored program specific to me to reach my goals
I need someone to help with accountability, motivation and support
I would benefit from having a personal trainer or online coach to achieve my goals
Strongly Disagree
Row 0, Column 0
Disagree
Row 0, Column 1
Neither disagree or agree
Row 0, Column 2
Agree
Row 0, Column 3
Strongly Agree
Row 0, Column 4
Strongly Disagree
Row 1, Column 0
Disagree
Row 1, Column 1
Neither disagree or agree
Row 1, Column 2
Agree
Row 1, Column 3
Strongly Agree
Row 1, Column 4
Strongly Disagree
Row 2, Column 0
Disagree
Row 2, Column 1
Neither disagree or agree
Row 2, Column 2
Agree
Row 2, Column 3
Strongly Agree
Row 2, Column 4
Strongly Disagree
Row 3, Column 0
Disagree
Row 3, Column 1
Neither disagree or agree
Row 3, Column 2
Agree
Row 3, Column 3
Strongly Agree
Row 3, Column 4
Strongly Disagree
Row 4, Column 0
Disagree
Row 4, Column 1
Neither disagree or agree
Row 4, Column 2
Agree
Row 4, Column 3
Strongly Agree
Row 4, Column 4
Strongly Disagree
Row 5, Column 0
Disagree
Row 5, Column 1
Neither disagree or agree
Row 5, Column 2
Agree
Row 5, Column 3
Strongly Agree
Row 5, Column 4
Strongly Disagree
Row 6, Column 0
Disagree
Row 6, Column 1
Neither disagree or agree
Row 6, Column 2
Agree
Row 6, Column 3
Strongly Agree
Row 6, Column 4
1
of 7
Previous
Next
Submit
Press
Enter
7
If I was to offer you a consultation to discuss these answers even further and explore the benefits of personal training sessions, would you be interested?
*
This field is required.
Yes
No
Maybe
Yes
No
Maybe
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
7
See All
Go Back
Submit
