MOVEWELL Online Coaching
Questionnaire
Full Name
*
First Name
Last Name
Gender
Male
Female
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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31
Day
Please select a year
2026
2025
2024
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2022
2021
2020
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Year
Height
cm
Weight
KG
What do you do for a living?
Whats the activity level at your job?
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Do you have any regular physical activities or strenuous hobbies?
Do you have any diagnosed health problems?
If you have any injuries, please list them.
Are you experiencing any stresses or motivational problems?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
Please list:
Are you a current cigarette smoker or vaper?
Yes
No
How would you define your diet:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
What is your goal with your training?
What goal/s best fit with you?
Increase General Fitness
Build Strength
Body Toning / Shaping
Increased muscle mass
Weight / Fat loss
What Gym/Equipment do you have access to?
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (+61 000 000 000).
Submit
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