Fitness Assessment Name * Name First Name First Name Last Name Last Name Phone * Email * What is your primary fitness goal? * Why is this goal important to you? * What are the biggest barriers to your success? * Do you have any health conditions? * physical condition, impairment or disability, including a joint or muscle problem, that should be considered before you begin a fitness program? Do you smoke cigarettes or vape? * Yes No How serious are you about achieving your goal? * 1 Not Motivated 2 A Little Motivated 3 Fairly Motivated 4 Very Motivated 5 Extremely Motivated How much are you willing to invest into your goals? * Do you have any food allergies? * Do you have a gym membership? * Yes No How often do you currently exercise each week? * Not at all 1 – 2 times per week 3 – 4 times per week 5 – 6 times per week Submit If you are human, leave this field blank.
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