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24Questions

1
Name
First Name
Last Name
2
Email
example@example.com
3
Phone Number
Please enter a valid phone number.
4
Phone Number
Please enter a valid phone number.
5
Date
Date
Year
Month
Day
6
Do you have any medical conditions?
YESNO
7
Are you currently taking any medications?
YESNO
8
Have you had any past injuries or surgeries?
YESNO
9
Do you experience chronic pain?
YESNO
10
What is your current activity level?
☐ Sedentary (little to no exercise)
☐ Lightly Active (1-2x/week)
☐ Moderately Active (3-4x/week)
☐ Very Active (5+ times/week)
11
Have you worked with a trainer before?
YESNO
12
What types of exercise do you enjoy?
☐ Strength Training
☐ Yoga/Pilates
☐ Running/Jogging
☐ Cycling
☐ Swimming
☐ HIIT
☐ Team Sports
Other
13
What exercises do you dislike?
☐ Heavy Lifting
☐ Cardio Machines
☐ Burpees/Plyometrics
☐ Stretching/Mobility
Other
14
How would you describe your current diet?
☐ Balanced & Healthy
☐ Inconsistent
☐ High in Processed Foods
☐ Other: _______________
15
Do you have food allergies/intolerances?
YESNO
16
How many meals do you eat daily?
☐ 1-2
☐ 3
☐ 4+
☐ Irregular
17
Do you track food intake?
YESNO
18
Biggest nutritional challenge?
☐ Portion Control
☐ Sugar Cravings
☐ Protein Intake
☐ Meal Prep/Time
19
Water intake per day?
☐ < 4 cups
☐ 4-8 cups
☐ 8+ cups
20
Caffeine consumption?
☐ None
☐ 1-2 cups/day
☐ 3-4 cups/day
☐ 5+ cups/day
21
Sleep per night?
☐ < 5 hours
☐ 5-7 hours
☐ 7-9 hours
22
What motivates you?
☐ Better Health
☐ Weight Loss/Gain
☐ Stress Relief
☐ Increased Energy
☐ Sports Performance
☐ Other: _______________
23
Biggest obstacles?
☐ Time Constraints
☐ Lack of Motivation
☐ Injury/Pain
☐ Nutrition Knowledge
☐ Other: _______________
24
Anything else I should know?
Huge
Large
Normal
Small
Ok
Ok
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