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  2. 2017
  3. January
  4. C
  5. Client Questionnaire
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Questions marked with a * are required Exit Survey
 
Contact Information
First Name : 
Last Name : 
* Phone : 
* Email Address : 
 
 
 
What services do you have interest in?
 
Coaching
 
Workout Plan
 
Nutrition Program

 
 
 
Age:
   
Gender:
   
Current Height:
   
Current Weight (lbs):
   
 
 
 
* Current Height?
   
 
 
 
* Current Weight (lbs.)?
   
 
 
 
* What are your health and fitness goals (Select all that apply)?
 
Decrease Body Fat
 
Increase Strength and Power
 
Reduce Stress
 
Improve Athletic Performance
 
Tone Muscles
 
Maintain Current Health

 
 
 
* What is keeping you from achieving your Health and Fitness goals (Select all that apply)?
 
Lack of Motivation
 
Too little time for exercise
 
Not knowing what to do
 
Hitting a plateau

 
 
 
Please select all activities/exercises you are comfortable with attempting, or you have done before (Select all that apply)?
 
Running/Jogging
 
Walking/Hiking
 
Weight Lifting (Free Weights)
 
Circuit Training/Group Exercise Classes
 
Biking
 
Swimming
 
Yoga
 
KettleBells

 
 
 
What time of day would you prefer to workout?
   
 
 
 
Do you have a gym membership? If not, do you own any exercise equipment? It's okay if you don't :)