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* 1. Please fill out the following:

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* 2. Which best describes your overall fitness/health goals?

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* 3. What are your health/fitness goals?  They can be short term, long term, general, or specific – and it does not have to be number related!!  (Ex. “I want to be able to run a 5k by 2019” vs. “I want to lose 30 lbs.”)

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* 4. Do you have any past experience with working out/sports/training, etc?  If so, please explain:

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* 5. What, if anything, do you think has prevented you from reaching your goals/motivating you in the past?

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* 6. Do you have any injuries or illnesses that may limit exercise or range of motion?

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