Request edit access
FitLife Fresno Application
Please fill out the information below as best as you can.
Name *
Your answer
Gender *
Required
Height *
Your answer
Birth Date *
Your answer
Weight *
Your answer
Phone Number *
Your answer
Address
Your answer
Email Address *
Your answer
How did you find out about FitLife Fresno *
Required
When are you available to train Monday through Friday? (Check all that apply) *
Required
Primary Physician
Your answer
Physician Phone Number
Your answer
Medications
Your answer
Do you have or ever had
Do you have or have had any serious illness not listed above?
If Yes, Please Explain
Your answer
Which sports have you played?
Your answer
Do you regularly exercise?
How often do you exercise?
What are your long term health goals?
Your answer
What is your Motivation for getting fit?
How serious is your health to you?
Not Serious
Very Serious
How much time are you willing to commit to reaching your goals?
What is Healthy Eating to you?
Your answer
Do you eat at least 2 servings of fruits and vegetables a day?
How many times do you eat out?
Are you Emotionally attached to food?
Do you eat when you are nervous or sad?
Would you say you have a healthy diet?
What changes right now could you make to improve your health?
Your answer
In what ways can you make fitness a priority?
Your answer
List two short term goals you have for the next three months.
Your answer
What do you need from FitLife Fresno to reach those goals?
Your answer
How will you reward yourself for reaching these goals?
Your answer
Any Additional Comments?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Fresno State. Report Abuse - Terms of Service