Fitness Questionnaire

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Thank you for your interest in the Jumpstart Package and taking the first step toward transforming your health and fitness. This short questionnaire helps me understand your goals, motivations, and current fitness level so I can design a program tailored specifically for you. Take a few minutes to complete the questionnaire thoughtfully—it’s the first step toward your transformation. Let’s make 2025 your strongest, healthiest year yet. I’m excited to help you get started!
Email*
example@example.com
Name*

First NameLast Name
What is your Cell Phone number?*
Please enter a valid phone number.
What is your age?*
What is your height?*
What is your weight?*
Describe your experience with strength training:*

None - Zero prior experiance with strength trainingLess than 1 year strength training experience1-2 years strength training experience2-3 years strength training experience3-4 years strength training experience4+ years strength training experience
How Many times per week do you currently exercise in the gym?*

None1-2 times per week2-3 times per week3-4 times per week4+ times per week
What are your fitness goals? (Please select all that apply)*

Lose weightBuild MuscleGet strongerLearn to lift weights properlyRehab an injuryImprove mobility and flexibilityImprove energy levelsBetter nutrition and diet habitsCompete in a sport/event/competitionIncrease confidence levelsOther
On a scale of 1 to 5 (5 being the most), how likely do you believe it is that you will have success in achieving these goals on your own without coaching?*

12345
What is your reason(s) for wanting to work with a personal trainer? (Please select all that apply)*

I have no idea what i am doing in the gymI am new to strength training and I want to learn to lift weights properlyI need extra motivation to reach my goalsI need someone to help keep me accountableI find it hard to go to the gym by myselfI need someone to push me harder in the gymI want to learn techniques for specific exercisesI have an injury I want to rehabI am bored of my current RoutineI am competing in an upcoming sport/event/hobbyI've worked with a personal trainer in the past and enjoyed itI just want to show up to the gym and be told what to doI want to take my fitness to the next levelI want to get in the best shape of my lifeUpcoming event/wedding/vacationOther
What would you say is you #1 struggle with your health and fitness?*
How long has this been your #1 struggle with your health and fitness?*

0-3 months3-6 months6-12 months12 months+
What would you say is your #1 most important goal you're looking to achieve with your health and fitness this year?*
Do you have any current injuries that could be of concern for strength training? If yes, please describe.
Have you worked with a personal trainer in the past? If yes, please describe the experience.
If the program was the right fit for you, how willing and able are you to invest in your health and fitness goals today?*

I have the financial resources to invest in my health and fitness todayI can get access to the financial resources to invest in my health and fitness todayI do not have the financial resources to invest in my health and fitness today
How soon are you looking to get started if the program was the right fit for you?*

Right away - as soon as possibleWithin the next monthWithin the next 1-2 monthsWithin the next 2-3 monthsI am not sure
What times and days are you available to train during the week? (Please select all that apply)*

Weekday - MorningsWeekday - AfternoonsWeekday - EveningsWeekend - MorningsWeekend - AfternoonsAnytime
Finally, please tell me a little bit about yourself away from fitness (work, family, hobbies, lifestyle, etc.)
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