H.F. Consultation Survey
Name
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Which best describes you?
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Precontemplation – I'm not considering change and may not see a problem with my health and fitness.
Contemplation – I recognizes a problem but feel anxious about change.
Preparation – I am planning to take action soon.
Action – I am actively taking steps toward change.
Maintenance – I am sustaining healthy noticeable positive changes but want to prevent relapse.
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Are you Ready to change for the better of your health?
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Strongly agree
Agree
Somewhat agree
Getting there
I’m just curious and/or am being forced to work on my health by circumstances
I don't know but I’m willing to get educated and associated with health conscious material.
If you are interested in a Health and Wellness Program, services, resources or tools to help you achieve a healthier you how would you summarize your state of readiness in 2-3 sentences and/ or What are you hoping to get from us?
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Are you interested in a holistic health program, service and/ or challenge in the following areas of health and fitness? I.e. physical fitness, nutrition , social/mental health, spiritual/ (greater purpose) ?
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Strongly agree
Agree
Somewhat agree
I don’t need that and/or aren’t interested.
I dont know yet/ not sure
other
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Should you choose to address and pursue your Health and Fitness Goals with us which one would you prefer the most?
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An highly engaged Accelerated Health & Fitness Service/ Program and or resources and tools I.e with one-on-one attention (That’s structured for a good Fit for you?)
A occasional Tune up session: I.e Continuing Education and/or an Accountability type of services with 1 on 1 attention?(That's a good fit for you?)
A Community/ group Driven Club (I.e Thats designed to give you comradely and a supporting environment ) while you pursue and achieve your health and fitness goals.
A mixture of all of the above
I'm not sure
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How many days a week would you like accountability, support and/ or a level of contact of Coaching and /or Consulting attention should you find yourself working with us?
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Coaching and consulting most days of the week 4-5 days week
3-4 days of the week
2-3 days a week
1-2 Days a week
I don’t know or when I can
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In the last 3 months have you exercised at least 3 days/ sessions a week for at least 30 mins a day while using the exercise guidelines from a qualified Health professional, institution or entity?
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Yes I do all the time
Yes I do Sometimes but I know I need to do better
Sporadically I follow proper exercise methods but its boring and or I need more accountability
Rarely or not at all because I don’t have a lot of time
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How will your life be different for the better when you achieve your fitness goals?
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Extremely better
Better
Somewhat better
I’m not sure
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Ever Work With a trainer before? How was your experience?
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Very good
Good
Neutral
Bad
I have never worked with a Trainer Before
Have worked with a trainer? What was your favorite thing about working out? Least favorite thing about training?
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Could Time interfere with your Health & Fitness goals ?
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Yes
No
Somewhat
Kind of because I'm unavailable most days of the week
Very much since I’m really busy
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Could Money interfere with your health and fitness goals?
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Money is not a problem
As long as price in my area is the average cost for the services I’m seeking money isn’t a problem
I am on a fixed budget so money could be an issue and I have set aside some funds for my health and may need you to work with my budget
I am almost sure that money is going to be an issue since I see the average rate on my area is outside of my budget so I can only invest so much
Money is a major challenge, but I still want to begin changing my health & Wellness for the better
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Could Energy interfere with your health and fitness goals?
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Yes
No
Sometimes energy is an issue
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Could support interfere with your health and fitness goals
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Yes, I literally have no support for my health and wellness goals
Most days of the week I don’t have support
Some days of the week I don’t have support
Less than 2 days aweek I don’t have support
I have a-lot of support at home/ or with others so I need very little support if any.
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Could the lack of regular contact with your Health Coach/ Trainer interfere with your health and wellness goals due to not being able to meet with them in person?
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Yes and I am counting on that accountability
Somewhat agree
Agree
I Don't agree
If
wasn’t a problem to your fitness goals would there be anything else? Y or n
Feedback
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Do you have a home gym with exercise equipment? Or a gym membership?
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No equipment but gym membership
No gym membership and don't own any equipment.
Have Some equipment home but no gym membership
Have Some Equipment and Gym Membership
I have pretty much a full gym setup in my house or where I live And Gym Equipment and multiple locations
I have no gym equipment or membership of any kind
Please list equipments
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How many days of a week and hours can you work on your health and fitness goals for yourself outside a 1 on 1 session with your trainer?
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1-2 hours a week
2-3 hours/ week
3-4 hours / week
4-5 hours/ week
I don't know
Feedback
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How many days a week on average did you need to commit on your latest big accomplishment? (I.e College, military boot camp, job training , etc)
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4-5 days a week
3-4 days a week
2-3 Days a week
1-2 Times / week.
What we’re some of the impactful moments and or experiences that lead to your success in the above endeavor that you can carry over in your health and fitness quest?
What type of exercises do you like(I.e. functional training, core training, strength training, endurance training, mobility training, power training, sports specific training or anyway you want to describe.
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Why are you taking steps towards your health goals “now “ versus a week or more ago (I.e. why is this good timing for you to take action to be in better health at this point in your life? )
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I strongly agree that nothing could get in the way of me getting healthy and that I can overcome and/or I have the best opportunity to get healthy
Agree
Somewhat agree
Not sure
I know it’s not a good time but I think that season is coming so I would like to get the ball rolling
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Which one best describes you?
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Don’t ignore me and connect with me through excitement b/c I get bored easily
Melancholy: Be Sensitive with me and keep order with me otherwise It’s a turnoff.
Choleric: Appreciate me, b/c I like control so leave things up to me
Phlegmatic: Respect me b/c I desire peace and assurance and resent change for the most part.
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Where were you when you made the decision to start getting in shape? was anyone around/ situation? /phenomenon, crisis ?
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What do you Care about the most/ what drives you ? I.e. F.O.R.M (Family occupation Recreation Motivation or a dream)
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Why does it matter you, to use what matters to you as an inspiration to get in the best shape of your life ? Give me 5 reasons.
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Can Anyone /Anything else benefit you being in or getting in shape?
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What are some S.M.A.R.T short term things you can do right away to get on track towards your long term fitness goals? Specific (The specific goal):Measurable (Over a period can you rate it?):Attainable (Is it a goal that you are capable and prepared to achieve ?):Realistic:(Is it in consideration of your situation?)Time:(Are you willing to evaluate your progress on this goal?)
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What are some of your hobbies I.e. physically hobbies?
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Is there any immediate ongoing consequences that you are reaping everyday your health goals don’t have progress and/ or not yet?
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Yes very much so
Yes to a Fair extent
It’s starting to
Neutral
Not at all
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What category do you fall in?
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Achieve health, wealth and/or wellness in all area in your life
Sustaining the desired health, wealth and/or wellness outcomes that you have acquired for ongoing / lifelong benefits.
Rebounding from losing good health that you onces had
It’s something else
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Ask me how pictures can get you a mega discount on your training!
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Readiness for Change Questionnaire
I'm sorry we do not have a program for you please reach out to you coach.
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