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Exercise Pre Screening Questionare
First name
*
Phone
*
Email
*
Birthday
*
Day
Month
Year
Occupation (and what does a typical workday look like?) e.g. desk-based, on your feet, mix of both
*
Do you have any current injuries, pain, or physical limitations? (If yes, please explain)
*
Are you currently taking any medications that would affect you working out in the gym?
*
Yes
No
Has a doctor ever told you to avoid certain types of exercise, or do you have any medical conditions I should know about?
*
How many days a week do you currently exercise?
*
None
1-2 days
3-4
5+
How many days per week can you commit to training?
1
2-3
3+
What type of physical activity do you usually do?
*
Gym / Weight Training
Cardio (Running, Cycling, etc.)
Group Fitness Classes
Sports (e.g., Tennis, Football, etc.)
Yoga/Pilates
I’m not currently active
Do you smoke / Vape?
*
Yes
No
What are your main Health & Fitness goals? Be Specific as possible
*
What has stopped you from achieving this in the past?
*
Are you currently a member of Jetts Fitness Eden Terrace?
*
Yes I'm a member of Jetts Eden Terrace
No Not yet
I'm a member of Jetts All Clubs
What is your Weekly Budget to Invest into Achieving your Health and Fitness Goals?
*
$50/Week to $80/Week
$80/Week to $120/Week
$120/Week to $150/Week
$150 +/Week
I work out of Jetts Eden Terrace, if we are a good fit will it be feasible for you to come to Jetts Eden Terrace?
No worries, I live close by.
No I can't, too far away from my home or work.
If my Personal Training service is a good fit, are you prepared to begin training within the next 1–2 weeks
Yes
Maybe, depends on Schedule
No, not right now
What makes now the right time for you to work on your health/fitness?
*
If we work together and you achieve your goal, what will that mean for your life in the next 6–12 months?
*
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