Online and Virtual Training Questionnaire
Welcome to the Better Mind - Better Body - Better Lift Community! I am super excited to work with you! Before we can get started, please fill out the questionnaire below. Please be as detailed as possible. The more I know about you, the better I will be able to tailor the program to your needs.
Name
*
First Name
Last Name
Please provide FULL address incl Apt # if applicable. If your program includes workbooks we will use this address to send them to you.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation
Height
Current Weight
Do you smoke?
Yes
No
If yes, how many cigarettes per day?
Do you drink alcohol?
Yes
No
If yes, how often/much?
Are you pregnant?
Yes
No
If you have a child, were you ever diagnosed with Diastasis Recti after giving birth?
Yes
No
Physical Activity
Why did you decide to start a physical fitness training program and what do you expect?
What are your goals?
Did you work with a trainer before (online or offline)? If so, tell me about your experience.
Do you currently work out?
Yes
No
I wouldn't call it "working out"
If so, how often?
Please Select
Once a Week
Two - Three Times a Week
More Than Three Times a Week
Twice a Month
Once a Month
Occasionally
If you currently work out, please describe exactly what you are doing (the more detailed you are, the better)
Do you have access to a gym?
Yes
No
Do you have exercise equipment at home?
Yes
No
If yes, please describe the equipment (e.g. free weights, resistance bands, stability ball, etc.)
Where do you want to do your workouts?
Which days of the week are you able to workout? Please check all available days. That doesn't mean you will have to workout on all of these days.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How many days per week are you (realistically!!) able to workout?
0
1-2
2-3
3-4
more than 4
Do you have a fitness tracker (FitBit, Apple Watch, Garmin etc)?
Yes
No
Please describe your biggest challenges when it comes to working out
Nutrition
How many meals do you eat per day?
Are you vegan or vegetarian?
Yes
No
Do you have any kind of food allergies or restrictions?
Yes
No
If yes, please explain
What's your favorite food?
Do you take any supplements? If so, please list them.
Describe your biggest challenges when it comes to healthy eating
Psychological and Physical Well-being
Lack of appetite
Please Select
Yes
No
Sometimes
Insomnia
Please Select
Yes
No
Sometimes
Difficulty in Concentrating
Please Select
Yes
No
Sometimes
Depression
Please Select
Yes
No
Sometimes
Lack of Motivation
Please Select
Yes
No
Sometimes
Fatigue
Please Select
Yes
No
Sometimes
Stressed out
Please Select
Yes
No
Sometimes
Other Information
Is there anything else I should know?
Submit
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