FLEXCOFIT LIFESTYLE QUESTIONNAIRE

1

Full name* This field is required.Please write your full name so our coach can contact you

First Name

Last Name

2

Phone Number* This field is required.

3

Email* This field is required.

example@example.com

4

Please declare any health conditions or disabilities* This field is required.If not applicable answer with N/A

5

How do your condition(s) affect your diet/lifestyle/ability to exercise * This field is required.If not applicable answer with N/A

6

How many days per week do you do at least 30 minutes of physical activity?

Never (0)

1-2 days (3)

3-4 days (6)

5-6 days (8)

Every day (10)

7

How would you rate the intensity and effectiveness of your exercise?

Very poor (0)

Below avarage (3)

Moderate (6)

Good (8)

Excellent (10)

8

How balanced is your diet (protein, vegetables, carbs, healthy fats)?

Never balanced (0)

Rarely balanced (3)

Sometimes balanced (6)

Mostly balanced (8)

Always balanced (10)

9

How often do you eat processed or fast food?

Daily (0)

4-5 times/week (3)

2-3 times/week (6)

1 time/week (8)

Rarely/Never (10)

11

How many hours of quality sleep do you get on average per night?

Less than 4 hrs (0)

4-5 hrs (3)

6 hrs (6)

7 hrs (8)

8+ hrs (10)

17

How consistent are you with maintaining healthy routines (exercise, eating, sleep)?

Never (0)

Rarely (3)

Sometimes (6)

Often (8)

Always (10)