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2. Fitness Screening Questionnaire
1.
First and Last Name
2.
What are your Fitness & Nutrition goals? (Check top 3 most important goals)
Learn to eat a Balanced Diet
Decrease Body Fat Tone Muscles
Learn to Balance Activity & Diet Reduce Stress
Increase Strength & Power Create a Healthy Lifestyle
Feel Better Improve Speed/Agility
Improve Overall Health
Increase Flexibility
Improve Athletic Performance
Maintain a Healthy Weight
Increase Endurance
Other (please specify)
3.
What is keeping you from achieving your Fitness & Nutrition goals? (Check all that apply)
Time
Lack of Equipment
Hitting a Plateau
Self Conscious
Not Knowing Where/How to Begin
Money
Lack of Results
Other (Please Specify)
4.
What motivates you? (Check all that apply)
Seeing Results
Having Fun
Praise/Rewards
Accountability
Feeling Better
Other (Please Specify)
5.
Do you follow a current exercise regime?
Yes
No
If yes, please explain
6.
Have you ever done personal training before?
Yes
No
If yes, please explain: (How long ago? Was your experience beneficial?)
7.
What do you expect from a personal trainer?
8.
What activities/exercises do you currently participate in? (Check all that apply)
Running/Walking
Aerobics
Strength
Circuit
Biking
Dance
Free Weights
Swimming
Yoga/Pilates
Resistance Training
Outdoor Activities
Martial Arts
Recreational Activities
Calisthenics
Golf
Conditioning
Athletics/Other: If so, what...
9.
What is your current activity level?
None
Little (Less than one hour a week)
Moderate (1-5 hours a week)
High (Over 5 hrs. a week)
10.
Have you had any recent weight gain or loss?
Yes
No
If yes, please explain.