Name
*
First Name
Last Name
Email Address
*
You're about to start a 6-week program. What do you want to achieve
Why
For the next 6 weeks, what is your desired level of commitment
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6/10 Moderately Active Lifetstyle
7/10 steady progress, but fitness isn't my main focus
8/10 Let's do this. Time to get in shape, but I have some life to live too
9/10 Right now, fitness is my priority
10/10. 100%, training breathing eating sleeping
Desired level of program flexibility
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Structured: Make it simple for me, just tell me what to do and when to do it so I don't have to think about it
Flexible: Give me a general guideline and I'll fit it into my schedule and figure out the details. I want some choice and I'll take responsibility for some of my own planning.
Are you specifically interested in improving performance in
Of the above, which (if any) are priorities
Would you be interested in trying any of the following, if equipment, access, technical know-how or your fitness level weren't issues
Other
What are your fitness goals
Other
Of the above, which are priorities
Do you have a specific event, goal or milestone you're preparing for.
Specific Performance Goal?
Specific Physical Goal?
Specific Lifestyle goal?
Other goals?
How important are these goals to you. Why
Rate your overall activity level, considering both workouts and non-exercise related activity
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Sedentary
Somewhat active
Active
Very Active
Extremely Active
Describe your overall activity level, on a daily and on a weekly basis, including structured workouts and general activity (i.e riding your bike to work, physical job, etc.)
How frequently do you currently work out
Rate or describe your exercise experience level
Your ability to perform strength exercises
Your ability to perform mobility exercises
Your ability to perform cardio exercises
Describe your current or previous fitness regimen
What facilities do you have access to - i.e. gym, home gym or equipment at home, outdoor park or outdoor features (i.e. hill, stairs near home), gym at work, etc. Describe
What equipment do you have access to
Other or Describe
What equipment are you comfortable using
Other/Describe
What equipment would you like to learn how to use
Would you like to coordinate any of your workouts with a particular person or group? Who? How many sessions per week?
Do you want to incorporate certain activities, sports or classes into your workout program
How many sessions at each facility? i.e 3 gym workouts 2 outdoor workouts, or 2 home workouts 1 gym workout
Details
Schedule considerations for the next 6 weeks (i.e. business trips, social events, vacations, etc.
How many days per week are you willing to work out over the next 6 weeks (include non-gym sessions, i.e. cycling, swimming, climbing gym)
How much time will you dedicate to each session
Apart from your structured workouts, how much time are you willing to dedicate daily to your fitness development. i.e 5 minutes before bed, 10 minutes first thing each morning, periodic breaks through the day at work...
Describe your daily and weekly routine. Include details about your commute, work, sleep habits, and anything that may be useful in developing your program.
Briefly summarize your fitness or lifestyle goals
Why is this important
Why haven't you achieved it in the past
Vices/Indulgences: Any you're willing to cut back on? Any you would like to keep?
Any existing injuries or conditions we should take into account
Anything else you would like to mention
