Built By Andi - Assessment Form

Assessment Form

Completion time : ±5minutes
Name & Surname

First NameLast Name
MaleFemale
Age
years
Height
cm
Weight
KG
What do you do for a living?
None (seated only)Moderate (light activity such as walking)High (heavy labor, very active)Interchangeable ( Mix of moderate and heavy)
Do you follow a regular working schedule, do you work mostly days, afternoon or nights?
0-1 times a week1-2 times week2-3 times a week3-4 times a week4+ times a week
Please list the physical activities that you participate in outside of the gym and outside of work:
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any injuries history of injuries, please list them.
YesNo
YesNo
Please note any NB information you feel as though we at 'Built by Andi' need to know about your health :
Low-fatLow-carbHigh-proteinVegetarian/VeganNo special diet
Do you have any food allergies or specific dietary limitations ?
Improved healthImproved enduranceIncreased strengthIncreased muscle massFat loss
What is your goal with your training?
30minutes40minutes60minutes
once a weektwice a weekthree times a weekfour times a week
What is currently your biggest challenge/barrier to achieving our goals?
If there was ONE word that best describes you as a person what would that word be ?
Terms & Conditions

1. Disclaimer
Your programme is for general fitness guidance only and is not a substitute for medical advice.

2. Assumption of Risk
By participating, clients accept that all exercise carries a risk of injury. They agree to train within their own limits and inform you of any health issues.

3. Accuracy of Information
Clients are responsible for providing truthful and complete information (health history, injuries, goals, etc.) so the plan can be designed safely and effectively.

4. No Guarantees
Results vary depending on consistency, effort, nutrition, and individual differences. You can’t guarantee a specific outcome (e.g., “lose 10kg in 4 weeks”).

8. Programme Access
Plans are personalised for one client only and cannot be copied, resold, or shared.
YesNo
NB: Payment & Confirmation

Once you have completed and submitted your assessment, you will receive an email confirming that your programme is being built.

You will receive a second email & invoice once your programme is ready.
Before receiving your programme, you must pay the R149 fee and send proof of payment to builtbyandi@gmail.com.

Payment reference: Name & Surname

Programmes are non-refundable once delivered.
My Products
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Bronze Builder
4 Week plan

149.00ZAR Quantity
Item subtotal:0.00ZAR

Total

0.00ZAR
Email
example@example.com
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Assessment Form

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