Health Questionaire - Google Forms

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Section 1 of 1

Name

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Email

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Phone number

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Date of birth

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Gender

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Female yes

Male

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What is your motivation for joining Seagrass?

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Do you feel there is anything getting in the way of you achieving your goals?

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How would you rate your current fitness level

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1 (Low)

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How would you rate your motivation and readiness to start exercising?

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How would you rate your stress levels?

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How would you rate your emotional level?

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1 (Low)

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In Case of Emergency Contact Name:

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Relationship to you

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Are you currently under a doctor’s care?

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Yes

No

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If yes please explain why

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Occupation and hours worked per week if applicable

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Lifestyle Information

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Do you smoke?

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