Health and Fitness Assessment
I invite you to fill out my Health and Fitness Assessment to better serve you when we connect!
Phone Number (Cell Phone Preferred)
For calling/texting purposes only IF necessary. I promise to only use when needed - not for spamming as I hate that too. :-)
Which best fits your goal for the challenge?
Lose Weight (0-10 lbs)
Lose Weight (10-50 lbs)
Lose Weight (50-100 lbs or more)
Tone Up/Get Fit
WHY is this goal important to you? What would it mean if you achieved this goal?
Examples: "By wearing that black dress, I'd be fit and feel sexy again, like I was before we got married" or "By getting back in shape, I'll have the confidence to go after my dreams" or "I want to be around for my grandchildren"
Do you have an important event or date that you'd like to achieve your results by?
If so, please list the date below
What have you tried in the past that hasn't worked FOR YOU?
What type of workout do you like to do?
Martial Art Moves
Do you prefer High, Medium or Low Impact moves?
Do you have any physical challenges that would prevent you from doing a certain type of exercise?
If you answered "Feel Better", please describe how you are feeling now, and how you would like to feel better.
Example: I have no energy and want to feel energetic
What are your current eating habits?
My diet is all plant-based foods/vegan
My diet is all raw foods.
My diet is vegetarian.
My diet includes meat and dairy.
My diet is mostly fast food.
Do you have a preference for your meal plan?
Example: I'd like to move towards a plant-based diet.... a raw food diet..
Do you currently have a Team Beachbody Coach or have you ever bought a Beachbody program (P90X, Insanity, Turbo Jam, 21-Day Fix or other)?
If so, has your are you currently working with your Team Beachbody Coach or have they reached out to you recently?
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service