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* 1. Are you currently and consistently exercising a minimum of 30 minutes, 3-5 times per week.

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* 2. Please number the following health and fitness goals  with 1 being your highest priority and 10 being your lowest priority.

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* 3. Have you experienced success in the past in achieving your number one health and fitness goal?

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* 4. How important is it to you to achieve your number one health and fitness goals?

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* 5. In the past when you may not have achieved your goals or if you don't achieve your current goals  how did/will it make your feel? (tick as many response choices that are applicable)

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* 6. How many times have you attempted to achieve your number one health and fitness goals without success?

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* 7. Are you currently utilizing the services and expertise of a Personal Trainer or Weight Loss Coach?

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* 8. Have you ever considered getting professional assistance from a Personal Trainer or Weight Loss Coach?

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* 9. Would you like to have a Personal Trainer or Weight Loss Coach assist you with any of your health and fitness goals?

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* 10. Thank you for taking the time to respond to this survey on Your Health Your Future.  This survey will remain anonymous unless you chose to leave your full name and contact number below. If you do leave your full name and contact number below you will go in the draw to win a Personal Training or Weight Loss Coaching session to assist you in achieving your health and fitness goals. This prize will be drawn on August 1st, 2016.

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