SportFit Assessment Survey

1. Please tell us a bit about you.

Your information will be kept strictly confidential.
We will not share, distribute or sell your information in any way.

Please tell us a bit about you. Your information will be kept strictly confidential. We will not share, distribute or sell your information in any way. First Name:
Last Name:
Address 1:
Address:
City/Town:
State/Province:
ZIP/Postal Code:
Email Address:
Phone Number:

2. Are you under a doctor's care for any illness, ailment or disease? Please be specific.

Are you under a doctor's care for any illness, ailment or disease? Please be specific.

3. Please describe what, if any, medication you are currently taking. Please be specific.

Please describe what, if any, medication you are currently taking. Please be specific.

4. What are your health & fitness goals?

What are your health & fitness goals? Lose weight

Get in shape

Lower my blood pressure

Get Bigger

Get stronger

Get faster

Get leaner

Improve my sleep

Reduce stress

Improve in my sport

Improve in my hobby or fitness activity

Improve my overall health

Reduce my risk of heart attack

Reduce my risk of stroke

Reduce my risk of Alzheimer's, Parkinson's and dementia

5. Of your health and fitness goals, what are your top priorities?

Of your health and fitness goals, what are your top priorities? Highest priority
Second priority
Third priority

6. If you have body composition or weight loss goals, how much weight in bodyfat would you like to lose?

If you have body composition or weight loss goals, how much weight in bodyfat would you like to lose?

7. How much would you like to weigh?

How much would you like to weigh?

8. How much do you weigh?

How much do you weigh?

9. What is your height?

What is your height?

10. What is your waist size?

What is your waist size?

11. How much alcohol do you consume in an average week?

How much alcohol do you consume in an average week?

12. Do you consume alcohol daily?

Do you consume alcohol daily? Yes

13. Do you often yawn during the day?

Do you often yawn during the day? Yes

Never really noticed

14. Are you a shallow breather?

Are you a shallow breather? Yes

I don't know

15. Do you smoke?

Do you smoke? Yes

16. Do you like to set goals for yourself?

Do you like to set goals for yourself?

17. When you set goals, do you tell others what you're working on?

When you set goals, do you tell others what you're working on? Yes

Not usually

Never

Sometimes, it depends

1. General Information

1. Please tell us a bit about you.Your information will be kept strictly confidential.We will not share, distribute or sell your information in any way.