Fitness Questionnaire
Please fill out this form to the best of your ability. All of the information will be kept confidential and used only for the purpose of creating a personalized training program catered to your specific needs. Once we receive the form, we will reach out to you and set up a 30 minute virtual consultation/assessment. Looking forward to meeting you!
Basic Information
Full Name
First Name
Last Name
Gender
Female
Male
Date of birth
-
Month
-
Day
Year
Date
Today's Date
-
Month
-
Day
Year
Date
City & State
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred way to be contacted:
Email
Text
Phone call
Instagram
Emergency Contact (name & number)
Instagram (optional)
Current height
Current weight
Goal weight
Current body fat % (if known)
Occupation
Does your job require frequent long distance travel by car or plane?
Yes
No
Sometimes
Rate your daily stress level (1= very low; 10=very high)
How many hours do you regularly sleep at night?
Do you smoke? If yes, how often?
Medical History
Medical history (optional)
Please list any medical surgeries or illnesses you've had in the past:
Please list any medications you are currently taking
What other medical conditions/limitations should be considered before you participate in any exercise program?
Fitness Lifestyle
Current activity level
1. How many days a week do you currently exercise?
I don't
1-2 days
3-5 days
6+ days
2. How much time do you spend for a regular exercise?
0-30 mins
30-60 mins
60-90 mins
More than 90 mins
3. Where do you prefer to do exercise?
Gym
Home
Both
Other
4. When do you prefer to do exercise?
Early in the morning
In the middle of the day
Afternoon
Evening
What activities do you currently do for strength training? (weights, calisthetics, pilates, ect.) List number of days per week.
What activities do you currently do for aerobic exercise? (group classes, walking, cycling) List number of days per week.
Rate your current fitness level (1= unfit, 5=average, 10= very fit)
Desired personal training days & times
Desired number of sessions per week
6. What is your main goal for exercising?
Fat loss
Build lean muscle
Both fat loss & muscle gain
Other
11. What are your current fitness goals?
11. What motivates you best to reach your fitness goals?
12. What is the biggest challenge that can keep you away from your fitness goals?
Nutrition
Please list what you typically eat and drink during the following meal and around what time
Breakfast
Morning snack
Lunch
Afternoon snack
Dinner
Late night snack
Please list any vitamins or supplements you are currently taking
How many glasses of water do you consume per day?
Do you drink coffee? If so, how many cups per day?
Do you drink alcohol? If so, how many glasses per day or week?
Do you drink soda or juice? If so, how many glasses per day or week?
Submit
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