Felter Fitness Lifestyle Survey

Let's start with your full name*
What's your email*
example@example.com
What's your phone number*
What's your age*
What's your height*
What is your goal weight in pounds/dress size*
What is your current weight in pounds/dress size*
Lifestyle & Physical Activity
I want to learn more about your story as well as your current physical activity level.
How much time do you spend sitting still every day

1 to 3 hours3 to 6 hours6 to 9 hours9 or more hours
How many hours do you sleep every night

less than 5 hours5 to 6 hours6 to 7 hours7 to 8 hoursmore than 8 hours
How many days each week do you exercise

1 day or less2 to 3 days4 to 5 days6 days or more
How many minutes each day do you train when you exercise

less than 30 minutes30 to 45 minutes45 to 60 minutessmore than 60 minutes
How often do you do things that involve physical activity, like walking, hiking or playing sports, outside of formal exercise times

dailyweeklymonthlynever
How many meals do you eat every day

1 or less2 to 34 to 56 or more
Does anyone in your immediate family have chronic health problems, like diabetes or high cholesterol

YESNO
How many snacks do you eat every day

1 or less2 to 34 to 56 or more
How much water do you drink every day

less than 1 bottle2 to 3 bottles3 to 4 bottles4 or more bottles
How often do you eat fruits or vegetables

neversome mealsmost mealsevery meal
Do you ever drink alcohol

YESNO
What types of exercise do you like the most*
Do you use an app to keep track of what you eat

YESNO
What health goals would you like to achieve in the next 6-12 months*
What have you tried in the past and why hasn't it worked for you? What's stopping you from hitting your goal*
What will happen if you do not act now on these goals? Where will you be a year from now if you don't take action
Previous Diet History
You are what you eat right? well...it depends! Let's see what your eating habits look like.
How often do you eat food that has protein in it

neversome mealsmost mealsevery meal
Do you drink caffeine or other things that make you more alert

YESNO
How hungry do you usually feel after meals?

Still StarvingSatisfiedOver Stuffed
Have you ever felt like you couldn't stop eating a lot of food at one time, or felt like eating because of your emotions?

YESNO
How badly do you want to make the changes necessary to improve your diet? As in, is this a priority right now or a---I'll get to it when I can make time sometime in the future?

NOT MOTIVATEDHIGHLY MOTIVATE
Should be Empty:

Lifestyle & Physical Activity

Previous Diet History