• DEMOGRAPHICS

  • ETHNICITY
  • # OF CHILDREN
  • YOUR AGE
  • GENDER
  • MARITAL STATUS
  • HIGHEST LEVEL OF EDUCATION
  • EMPLOYMENT STATUS
  • DID YOU PLAY SPORTS IN HIGH SCHOOL?
  • DID YOU PLAY SPORTS IN COLLEGE?
  • DID YOUR MOTHER PLAY SPORTS IN COLLEGE?
  • DID YOUR FATHER PLAY SPORTS IN COLLEGE?

  • HEALTH BACKGROUND & HISTORY

  • DO YOU HAVE ASTHMA?
  • EVER HAVE PROBLEMS GETTING OXYGEN DURING EXERCISE?
  • HAVE YOU HAD PHYSICAL SURGERY BEFORE?
  • HAVE YOU HAD PHYSICAL THERAPY IN THE PAST?
  • HAVE YOU IN THE PAST, OR CURRENTLY SMOKE CIGARETTES?
  • HAVE YOU IN THE PAST, OR CURRENTLY SMOKE CIGARS?
  • HAVE YOU IN THE PAST, OR CURRENTLY SMOKE A VAPOR?
  • DO YOU CURRENTLY HAVE ANY NASAL ALLERGIES?
  • WHAT PHYSICAL RESTRICTIONS OR LIMITATIONS ARE YOU CURRENTLY EXPERIENCING?
  • ARE YOU ALLERGIC TO ANY FOODS OR MEDICATIONS? IF SO, PLEASE LIST THEM HERE.

  • LIFESTYLE

  • HOW WOULD YOU DESCRIBE YOUR CURRENT JOB WORKFLOW?
  • WHAT PERCENTAGE OF TRAVEL DOES YOUR JOB REQUIRE?
  • HOW WOULD YOU CATEGORIZE THE STRESS LEVELS AT WORK?
  • RATE YOUR QUALITY OF SLEEP?
  • RATE YOUR ENERGY IN THE MORNING?
  • ARE YOU TAKING ANY MULTI-VITAMINS?
  • ARE YOU TAKING SUPPLEMENTS?
  • HOW MANY MEALS DO YOU EAT PER DAY?
  • HOW MANY TIMES PER WEEK DO YOU EAT OUT?
  • DO YOU COOK YOUR OWN FOOD?
  • HOW OFTEN DO YOU EAT BREAKFAST?
  • TIME OF DAY YOU EAT SNACKS?
  • THE LATEST YOU EAT MEALS AT NIGHT?
  • LIST THE AREAS OF NUTRITION YOU WOULD LIKE TO IMPROVE IN?
  •    

  • EXERCISE

  • # OF DAYS A WEEK YOU HAVE PHYSICAL ACTIVITY?
  • YOUR MOST CONVENIENT DAYS TO WORKOUT? (Select all that apply)
  • WHAT PART OF THE DAY DO YOU PREFER TO TRAIN?
  • REALISTICALLY, HOW OFTEN YOU PREFER TO TRAIN EACH WEEK?

  • FOR EXERCISE, BETWEEN WHAT HOURS FIT YOUR SCHEDULE BEST?   PLEASE LIST HOURS IN SEPARATE BOXES.   (E.g. 9:00 - 11:00am, 5:00 - 8:00pm)

  • PLEASE LIST YOUR MOST FAVORITE TYPES OF PHYSICAL ACTIVITIES.   (E.g. Running, Outdoor Volleyball, Basketball, Boxing)

  • HAVE YOU EVER USED AN IN-HOME EXERCISE PROGRAM?   IF SO, WHAT TYPES.   (E.g. P-90x, Insanity, PiYo, Beachbody, Zumba, Tae Bo)

  • DO YOU PREFER TO EXERCISE?
  • IN WHAT FORMAT DO YOU PREFER TO TRAIN?
  • WHAT TYPE OF EQUIPMENT HAVE YOU USED BEFORE? CHECK ALL THAT APPLY.

  • CHALLENGES

  • WHAT ARE THE CONSTANT CHALLENGES THAT KEEP YOU FROM WORKING OUT? CHECK ALL THAT APPLY.
  • PRESENTLY, AT THIS TIME IN YOUR LIFE, WHAT PHASE DO YOU CONSIDER YOURSELF TO BE IN?
  • ASSUMING YOU'RE ACTIVELY EXERCISING, OR PREPARING TO START, WHAT WOULD YOU LIKE TO ACCOMPLISH? CHECK ALL THAT APPLY.

  • FITNESS MEMBERSHIP

  • WHAT HEALTH CLUBS ARE YOU CURRENTLY A MEMBER OF? (Check all that apply)

  • FOR HEALTH CLUB MEMBERSHIP, WHAT IS THE MINIMUM & MAXIMUM YOU'VE PAID PER MONTH?

  • HAVE YOU EVER BEEN A MEMBER OF A FITNESS STUDIO

  • FOR A FITNESS STUDIO, WHAT IS THE MINIMUM & MAXIMUM YOU'VE PAID PER MONTH?

  • EXERCISING AT A HEALTH CLUB OR STUDIO, WHAT CLASSES DID YOU TAKE?
  • HAS/IS YOUR FITNESS CLASS PARTICIPATION BEEN?
  • IN A CLASS, DO YOU PREFER THE SAME INSTRUCTOR?
  • HAVE YOU EVER PARTICIPATED IN A FITNESS EVENT

  • PRICING

  • AT PREVIOUS RESIDENTIAL PROPERTIES YOU'VE LIVED IN, DID THEY OFFER A HEALTH & FITNESS PROGRAM?
  • IF OFFERED NOW, WOULD YOU PREFER FITNESS CLASSES?
  • FOR A HEALTH & FITNESS PROGRAM, WHAT'S THE MAXIMUM YOU WOULD PAY PER MONTH?
  • Should be Empty: