The PhysIQ Performance Assessment

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Welcome to The PhysIQ Performance Assessment. Real transformation begins in the mind. This assessment helps us understand your goals, health history, lifestyle, training preferences, and mindset so we can create a personalized fitness experience built around you. Estimated completion time: 8–10 minutes.
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Full Name* This field is required.
First Name
Middle Name
Last Name
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Date of Birth* This field is required.
Date
Month
Day
Year
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Age* This field is required.
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Pronouns
Please Select
Please Select
She/Her
He/Him
They/Them
Prefer to self-describe
Prefer not to say
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Phone Number* This field is required.
Please enter a valid phone number.
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Email Address* This field is required.
example@example.com
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Occupation* This field is required.
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Preferred Contact Method* This field is required.
Phone
Email
Text Message
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Emergency Contact Name* This field is required.
First Name
Middle Name
Last Name
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Emergency Contact Relationship* This field is required.
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Emergency Contact Phone* This field is required.
Please enter a valid phone number.
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Medical Information Note
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Physician exercise restrictions
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Medical diagnoses
High blood pressure
Diabetes
Heart condition
Asthma
Arthritis
High cholesterol
Back pain
Joint pain
Pregnancy
Anxiety
Depression
Other
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If other, please explain
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Surgeries in the past five years
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Current or previous injuries
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Current medications
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Allergies or sensitivities
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Any of the following symptoms have occurred during or after exercise
Dizziness
Fainting
Chest discomfort
Unusual shortness of breath
None of the above
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Is physician clearance needed before exercise?* This field is required.
Yes
No
Unsure
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Is physician clearance available?
Yes
No
In progress
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How often do you currently exercise?* This field is required.
Daily
3-5 times per week
1-2 times per week
A few times per month
Rarely or never
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What types of exercise do you currently do?
Strength training
Cardio
Group classes
Sports
Yoga or Pilates
Walking or hiking
Mobility or stretching
Other
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How consistent have you been with exercise over the past 6 months?* This field is required.
Very consistent
Fairly consistent
Occasionally consistent
Inconsistent
Not consistent
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How would you describe your gym experience?* This field is required.
No experience
Beginner
Some experience
Comfortable and experienced
Very experienced
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What are your favorite physical activities?
Weight training
Running
Cycling
Swimming
Team sports
Classes or bootcamps
Yoga or mobility work
Outdoor activities
Other
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What activities do you enjoy the least?
Running
Heavy lifting
Machines
Group classes
High-intensity workouts
Flexibility work
Cardio equipment
Sports-based training
Other
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Do you have any mobility or movement limitations we should know about?
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How active are you on an average day?* This field is required.
Mostly sedentary
Lightly active
Moderately active
Very active
Extremely active
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How confident do you feel using gym equipment on your own?* This field is required.
1
2
3
4
5
6
7
8
9
10
Not confident
Very confident
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Have you worked with a personal trainer before?* This field is required.
No, never
Yes, briefly
Yes, for several months
Yes, long-term
Currently working with one
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Mindset First. Results Follow.
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What are your top three goals?* This field is required.
Fat loss
Muscle gain
Strength
Endurance
Mobility
Flexibility
Energy
Confidence
Athletic performance
Stress relief
General health
Other
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If you selected Other, please explain.
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Why do these goals matter to you right now?* This field is required.
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What does success look like in 90 days?* This field is required.
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What does success look like in one year?* This field is required.
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What do you think will happen if nothing changes?
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How committed are you to making these changes?* This field is required.
1
2
3
4
5
6
7
8
9
10
Not committed
Fully committed
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How confident are you that you can achieve these goals?* This field is required.
1
2
3
4
5
6
7
8
9
10
Not confident
Very confident
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What has prevented progress in the past?* This field is required.
Lack of time
Low motivation
Inconsistent routine
Injury or pain
Stress or burnout
Not sure what to do
Lack of support
Other
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What usually causes you to stop exercising?* This field is required.
Please Select
Please Select
Feeling too busy
Losing motivation
Pain or soreness
Not seeing results
Travel or schedule changes
Stress or fatigue
I do not usually stop
Other
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How do you usually respond after missing a workout?* This field is required.
Get back on track at the next opportunity
Feel discouraged but resume soon
Wait until the next week to restart
Often fall out of routine
I do not miss workouts often
Other
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What motivates you to keep going?* This field is required.
Improved health
Better energy
Looking better
Building strength
Reducing stress
Accountability
Performance goals
Confidence
Other
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What support do you need to stay consistent?* This field is required.
Accountability check-ins
Clear workout plan
Nutrition guidance
Scheduling help
Encouragement
Pain or injury modifications
Progress tracking
Other
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Who supports your fitness journey?
First Name
Middle Name
Last Name
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What is your biggest anticipated obstacle?* This field is required.
Please Select
Please Select
Time constraints
Motivation
Stress
Fatigue
Injury or pain
Travel
Family or work demands
Other
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Why is now the right time to start?* This field is required.
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What is one belief or habit you want to change?* This field is required.
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Work Schedule* This field is required.
Please Select
Please Select
Standard daytime
Shift work
Flexible
Remote
Variable
Other
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Hours Sitting Per Day* This field is required.
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Average Sleep per Night (Hours)* This field is required.
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Sleep Quality* This field is required.
Please Select
Please Select
Very poor
Poor
Fair
Good
Very good
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Energy Level* This field is required.
1
2
3
4
5
6
7
8
9
10
Very low
Very high
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Stress Level* This field is required.
1
2
3
4
5
6
7
8
9
10
Very low
Very high
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Travel Frequency* This field is required.
Please Select
Please Select
Rarely
Monthly
Weekly
Several times per week
Frequently
Other
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Family or Caregiving Responsibilities
Children
Elder care
Dependent care
Shared household duties
Other
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Water Intake (Liters per Day)* This field is required.
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Tobacco Use* This field is required.
Please Select
Please Select
Never
Former
Occasionally
Daily
Other
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Alcohol Frequency* This field is required.
Please Select
Please Select
Never
Less than weekly
1-2 times per week
3-4 times per week
Daily
Other
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Lifestyle Constraints
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How many meals do you typically eat per day?* This field is required.
Please Select
Please Select
1
2
3
4
5
6 or more
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How often do you eat out or order takeout?* This field is required.
Please Select
Please Select
Rarely
1–2 times per week
3–4 times per week
5 or more times per week
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Which best describes your usual eating pattern?* This field is required.
Balanced meals
High-protein focus
Low-carb focus
Vegetarian
Vegan
Pescatarian
Mixed/varied
Other
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Do you have any food allergies, sensitivities, or restrictions?
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Are there any foods you prefer to avoid?
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Do you find yourself eating in response to stress, boredom, or emotions?* This field is required.
Never
Rarely
Sometimes
Often
Very often
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Do you often eat late at night?* This field is required.
Never
Rarely
Sometimes
Often
Very often
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Which best describes your meal preparation habits?* This field is required.
I prepare most of my meals
I prepare some meals and eat some convenience foods
I mostly rely on convenience foods or takeout
I do not usually plan or prepare meals
Other
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About how much water do you drink per day?* This field is required.
Please Select
Please Select
Less than 2 cups
2–4 cups
5–7 cups
8–10 cups
More than 10 cups
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What supplements, if any, do you currently take?
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Would you like general nutrition accountability support?* This field is required.
Yes
No
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How many days per week do you prefer to train?* This field is required.
Please Select
Please Select
1 day
2 days
3 days
4 days
5 days
6+ days
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Preferred workout start time
9
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
00
10
20
30
40
50
Minutes
AM
AM
PM
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Preferred workout duration
Please Select
Please Select
15–30 minutes
30–45 minutes
45–60 minutes
60–75 minutes
75–90 minutes
90+ minutes
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Preferred training location
Please Select
Please Select
Home
Gym
Outdoor
Studio
Mixed
Other
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Do you prefer virtual or in-person training?
Virtual
In-person
Hybrid
No preference
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Do you prefer individual or small group training?
Individual
Small group
Either
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Preferred coaching style
Please Select
Please Select
Encouraging
Structured
Educational
High-energy
Calm
Direct
Tough-love
Flexible
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Preferred communication methods
Text message
Email
Phone call
App messaging
Video message
Other
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Accountability support preferences
Weekly check-ins
Daily check-ins
Workout reminders
Progress photos
Habit tracking
Meal tracking
Goal reviews
No additional accountability
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Scheduling limitations or unavailable times
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Exercises, movements, or training styles you do not want included
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I understand that meaningful transformation requires consistency, commitment, and honest communication. I agree to actively participate in my coaching experience and understand that my results will reflect the effort I invest.
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I acknowledge and agree.* This field is required.
I acknowledge and agree
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Participation is voluntary. Physical exercise involves inherent risks. I have disclosed any known medical conditions, injuries, medications, restrictions, and other relevant health information. I will stop and seek appropriate help if I experience chest pain, dizziness, faintness, unusual shortness of breath, severe pain, or unusual discomfort. No specific results are guaranteed. I remain responsible for following medical advice and obtaining clearance when appropriate. I release The PhysIQ and its trainer from liability to the fullest extent permitted by law.
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I acknowledge and agree.* This field is required.
I acknowledge and agree
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We collect personal, contact, lifestyle, fitness, and health information submitted through this assessment to evaluate fitness needs, personalize training, communicate with you, maintain records, and improve our services. We do not sell this information. We may share it only with your consent, with service providers needed to operate the program, or when legally required. Reasonable safeguards are used to protect your information, and you may contact The PhysIQ with privacy questions.
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I acknowledge and agree.* This field is required.
I acknowledge and agree
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Full Legal Name* This field is required.
First Name
Middle Name
Last Name
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Handwritten electronic signature* This field is required.
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Current Date* This field is required.
Date
Month
Day
Year
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