Fill Out the Questionnaire

Fitness Assessment

Please complete all required fields. Multi-selects are dropdowns with search and tags.

Your name

Your email

Gender

Date of Birth

Height

Weight

What are your fitness goals? (select up to 4)

Use the dropdown to add up to four items.

Primary goal

Why is this important now?

When would you like to achieve this?

Days per week committed

What obstacles might get in the way?

How will you feel when you achieve it?

Experience level

Worked with a trainer/coach?

Yes

Exercise part of life

Days/week last month

Physical activities you do weekly

Training you’d like to learn

Day in life (check all that apply)

Nutrition (1-10)

Sleep (1-10)

Stress (1-10)

Which needs priority support?

Recent signs/symptoms

Medical conditions

Any current/past injuries or surgeries?

Yes

Currently taking medications?

Yes

Any reason you should not do physical activity?

Yes

Anything else you would like me to know?

By submitting, you confirm the provided information is accurate.