Personal Fitness & Wellness Assessment Form
Please fill out this form to help us understand your fitness goals, experience, lifestyle, and readiness to commit.
Basic Info
Full Name
*
First Name
Last Name
Age
*
Height
*
Current Weight
*
Goal Weight (if applicable)
Goals
Main goal right now
*
Fat loss
Toning
Muscle gain
Glute growth
Overall fitness
Describe your goal in your own words
Experience
How many days per week can you realistically train?
*
Do you currently go to the gym?
*
Yes
No
What is your experience level?
*
Beginner
Intermediate
Advanced
Lifestyle
Do you have a physically active job?
*
Yes
No
What is your daily activity level?
*
Low
Moderate
High
Nutrition
Do you currently track your food?
*
Yes
No
Dietary restrictions or preferences
What does a typical day of eating look like?
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Access to equipment?
Please Select
Yes
No
Current injuries or pain?
Food allergies or preferences?
Sleep hours per night?
Stress level
1 - Very Low: I rarely feel stressed
2 - Low: I have occasional stress, but it’s manageable.
3 - Moderate: I experienced stress regularly, but can usually manage it.
4 - High: stress frequently affects my mood energy and daily routine.
5 - Very High: I feel overwhelmed most days and it impacts my health or ability to stay consistent.
Why now?
Submit
Should be Empty: