Exit 2. Fitness Screening Questionnaire Question Title * 1. First and Last Name Question Title * 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) Question Title * 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) Question Title * 4. What motivates you? (Check all that apply) Seeing Results Having Fun Praise/Rewards Accountability Feeling Better Other (Please Specify) Question Title * 5. Do you follow a current exercise regime? Yes No If yes, please explain Question Title * 6. Have you ever done personal training before? Yes No If yes, please explain: (How long ago? Was your experience beneficial?) Question Title * 7. What do you expect from a personal trainer? Question Title * 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... Question Title * 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) Question Title * 10. Have you had any recent weight gain or loss? Yes No If yes, please explain. Finish 2/3