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    Fitness Assessment and Questionnaire

    Thank you for your interest in my programs. The information gathered here will provide me with a better understanding as to how I can best help you to achieve your goals. I will be reaching out personally.

    Name:

    Email:

    Phone:

    Date of Birth:

    Height:

    Weight (current):

    Preferred method of communication (select as many as you like):

    1. What are your health and fitness goals? What would most like to achieve in 6 months? Please be as detailed as possible.

    2. Now be honest with yourself. Why do you believe you are not at your desired goal right now?

    3. On a scale of 1-10 how do you feel about your body right now? (10 being you would run down the street naked.)

    4. On a scale of 1-10 what are your energy levels right now? (1 being you can’t get out of bed.)

    5. Have you ever worked with a Personal Trainer before?

    6. How many times in the past have you tried to lose weight, gain muscle or a combination of both?

    7. Why do you feel this time will be different than all the past times you tried to lose weight, gain muscle or a combination of both?

    8. What qualities are you looking for in a weight loss program?

    9. Which one best describes you?

    10. What made you fill out this form today? Why now? Please be as detailed as possible. (Had enough, seen our ad, frustrated with lack of progress, etc.)

    11. How will your life be better when you finally reach your fitness goals, have the body of your dreams and you are living a healthy and fit lifestyle?