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Fill Out the Questionnaire
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Fill Out the Questionnaire
Comprehensive Fitness Assessment
Please complete all required fields. Multi-selects are dropdowns with search and tags.
Identity
Your name
Your email
Gender
Choose…
Female
Male
Non-binary
Prefer not to say
Date of Birth
Assessment Date
Height
cm
Weight
kg
Goals
What are your fitness goals?
(select up to 4)
Lose weight
Gain lean muscle mass
Increase overall strength
Get toned and defined
Improve cardiovascular fitness
Increase flexibility
Prepare for a life or athletic event
Recover from an injury
Learn a new movement or tool
Improve overall health
Use the dropdown to add up to four items.
Primary goal
Choose…
Lose weight
Gain lean muscle mass
Increase overall strength
Get toned and defined
Improve cardiovascular fitness
Increase flexibility
Prepare for a life or athletic event
Recover from an injury
Learn a new movement or tool
Improve overall health
Why is this important now?
Choose…
I want to maximize my health and wellness
I have an upcoming event
I recently set a goal
I am displeased with my current fitness/results
When would you like to achieve this?
Choose…
<1 Month
2-3 months
4-6 months
7-12 months
Days per week committed
What obstacles might get in the way?
Work
Family
Money
Time
School
Diet/Nutrition
Knowledge
Injury
No obstacles
Previous failures
How will you feel when you achieve it?
Confident
Proud
Energized
Sense of accomplishment
Motivated
Exercise History
Experience level
Choose…
Novice
Intermediate
Advanced
Worked with a trainer/coach?
Yes
No
Exercise part of life
Choose…
<6 months of training experience
6 months – 2 years of training
2+ years of training
Days/week last month
Choose…
Sometimes (1-2 days)
Often (3-4 days)
Frequently (5-7 days)
Preferences & Interests
Physical activities you do weekly
Walking
Cardio
Strength Training
Running
Group Fitness
Yoga
Cycling
Pilates
Spa/Massage Therapy
Marial arts/boxing
Personal Training
Boutique Classes
Training you’d like to learn
Yoga
Marial arts/boxing
TRX
Stretching/Mobility
Swimming
Kettlebells
ViPR
Lifestyle
Day in life (check all that apply)
Work - Sedentary/desk job
Commute
Work – travel/on the move
Meditation
Family/Children
School
Social events
Time to relax (books, TV)
Nutrition (1-10)
Sleep (1-10)
Stress (1-10)
Which needs priority support?
Choose…
Nutrition
Sleep
Stress
Medical & Orthopedic History
Recent signs/symptoms
Chest discomfort with exertion
Unreasonable breathlessness
Dizziness
Fainting
Blackouts
Ankle swelling
Rapid or irregular heart rate
Burning or cramping sensation in lower legs when walking short distance
Known heart murmur
None
Medical conditions
Heart attack
Heart surgery
Cardiac catheterization
Pacemaker/implantable cardiac defibrillator/rhythm disturbance
Heart valve disease
Heart failure
Heart transplantation
Congenital heart disease
Diabetes
Renal Disease
None
Any current/past injuries or surgeries?
Yes
No
Currently taking medications?
Yes
No
Any reason you should not do physical activity?
Yes
No
Submit Assessment
By submitting, you confirm the provided information is accurate.