Fitness survey
Fill in below to help me know about your body
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How old are you?
*
When would you like to start?
*
-
Month
-
Day
Year
Date
What is your primary fitness goal? Please select as many as you would like.
*
Lose weight
Build muscle
Improve endurance
Increase flexibility
Would you like to work on your nutrition?
*
Yes
No
Are you currently following any Pacific diet?
*
Yes
No
How many meals and snacks do you consume on a typical day?
*
1
2
3
4
5
Are you active now?
*
Yes
No
Do you currently have any health issues or injuries? Describe in your own words.
*
Do you workout at the moment?
*
Yes
No
Do you experience shortness of breath or difficulty breathing during physical activities?
*
Yes
No
Please select as many body parts that you would like to work on
*
Chest
Arms
Stomach / abs
Legs
Back
Have you worked with a fitness coach before?
*
Yes
No
In your own words, describe your body type
*
If you can wave a magic wand, what would your body goal be?
*
Submit
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