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Exercise Pre Screening Questionare
First name
*
Phone
*
Email
*
Birthday
*
Day
Month
Year
What best describes your current work or study situation?
Full-time employment
Part-time employment
Self-employed
Student/Studying
Not currently working
Do you have any current injuries?
*
Yes
No
If yes, please explain the injury.
Are you currently taking any medications that would affect you working out in the gym?
*
Yes
No
How many days a week do you currently exercise?
*
None
1-2 days
3-4
5+
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
What are your main Health & Fitness goals?
*
Do you smoke / Vape?
*
Yes
No
Do you drink Alcohol?
*
Yes
No
If Yes how many drinks would you have per week?
1-2
2-5
5-10
10+
How many times per week do you order takeout?
*
Never
1 time
2-3 times
more than 3 times
What is your biggest challenge when it comes to achieving your fitness goals?
*
Not enough time
No energy
Motivation / Accountability
Lack of Knowledge
Nutrition / Diet
Injuries / Physical Limitations
What is your Weekly Budget to Invest into Achieving your Health and Fitness Goals?
*
$60/Week to $100/Week
$100/Week to $150/Week
$150/Week to $200/Week
$200 +/Week
If my Personal Training service is a good fit, are you prepared to begin training within the next 1–4 weeks
Yes
Maybe, depends on Schedule
No, not right now
What makes now the right time for you to work on your health/fitness?
*
How many days per week can you commit to training?
1
2-3
3+
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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