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Health & Wellness Survey
1.
Please provide your first and last name:
2.
Check ALL fitness classes you would be interested in attending:
HIIT (High Intensity Interval Training)
Cardio Yoga
Wake up Stretch
Pilates
Stretch, Balance, and Recovery
Yogalates
Gentle Yoga
Yoga for a Health Back
Restoritive Yoga
Yin Yoga
Vinyasa Flow Yoga
Chair Yoga
Meditation and Breathing
Strength based (weights, bands, and balls)
Stretch and strengthen
Barre (using chairs)
Long, Lean, and Tone Strength Training
F.A.B.S. (functional active balance and strength designed for active seniors)
Ballroom Dance
Tango Dance
Cha cha Dance
Salsa Dance
Zumba (An interval training program that combines Latin and international music with dance moves to help improve cardiovascular fitness)
Golf Fitness (golf-specific strengthening and stretching)
Pickleball Fitness
Croquet Fitness
3.
How many times per week would you expect to attend a fitness class?
1
2
3
4
5
6
7
4.
What day(s) of the week would you prefer to attend classes? (please check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
5.
What is your preferred time(s) for attending class? (classes will be between 30 - 55 minutes depending on the class)
6:00 AM
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
6.
Are you interested in one-on-one personal training?
Yes
No
7.
If you answered yes, please select ALL personal training services you would be interested in taking:
Personal Fitness
Nutritional Counseling
Physical Therapy
Weight Management
Healthy Back
Sports Skills (enhancememnt and injury prevention for golf, pickleball, or croquet)
8.
Are you interested in ono-on-one golf training with a Titleist Performance Institute Certified trainer?
Yes
No
9.
Would you be interested in attending any of the lectures or workshops below (select ALL that apply):
Introduction to Fitness (the basic foundations of the Body Physiology)
Diet and Nutrition for Longevity
Navigating The Little Club Menu with Chef Quinn
Memory Improvement
Common aging challanges (arthritis, osteoporosis, and balance)
Mindful Training
Power of Breath
Meditation
Naturopathy and Chinese Medicine (chakras)
Introduction to anti-inflammatory lifestyle
Power of Optimisim
Other (please specify)
10.
Comments and Suggestions:
