FRESH! Client Onboarding Survey
The intention of this survey is to give us a picture of who you are, and help us to identify areas that we can have the greatest impact on your health & fitness goals. This is our pre-screening process, where we also identify any barriers (physical or psychological) that may be preventing you from reaching those goals, and how we can best be of service to you.

Please be as honest as possible, these answers will not be shared and will be used in aggregate with answers from existing and other potential clients to best guide our programs and services to suit everybody's needs.

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Basic Information & Contact Details
First Name *
Last Name *
Primary Email Address *
Mailing Address *
City *
Postal Code *
Mobile Phone Number *
Work Number
Health History & Medical Information
Health History Questions *
Please use comment section below to explain further or comment on an item.
Yes
No
Has your doctor ever said that you have a heart condition OR high blood pressure?
Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise)
Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?
Are you currently taking prescribed medications for a chronic medical condition?
Do you have a bone or joint problem that could be made worse by becoming more physically active? Please answer NO if you had a joint problem in the past, but it does not limit your current ability to be physically active. For example, knee, ankle, shoulder or other.
Has your doctor ever said that you should only do medically supervised activity?
Have you had a physical exam in the last 12 months?
Do you smoke?
Injuries, Aches, Pains, and Frustrations (Please be DETAILED) *
Please list ALL of the injuries you've had throughout your life. This includes everything from pulled muscles, broken bones, accidents (car, bike, falls, etc.) and anything else you can think of that causes you pain, injury or discomfort. If you don't think it's major...write it down anyway! You would be surprised how the littlest things can cause movement dysfunction down the road!                              
Stages of Change
Here are a number of statements describing various levels of physical activity. Please check the box that corresponds to the statement that most closely describes your current level of physical activity. *
Please note that moderate to vigorous activity would be an intensity where breathing permits the use of short sentences or 1 or 2 words only. This type of intensity needs to be sustained for at least 10 minutes at a time, for a minimum of 30 total minutes per day. If you do not reach these levels, this is considered being physically inactive for the purpose of this question.
If you are not currently physically active, were you physically active in the past? Please describe
Please rate your level of health today compared to others you know who are about the same age *
What is the most important thing for you to change about your health? *
Which of the following have prevented you from being more physically active? *
Please check all that apply
Required
Rank the top 3 barriers to physical activity participation from those you have just identified (#1, #2, #3)
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