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SSF Questionnaire
Montes.m1993@gmail.com
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Email *
Name: first and last *
Phone number  *
Social Media Handles *
What is your current health and wellness goal?  *
What is your biggest struggle you are having right now when it comes to your health and wellness journey?  *
Have you used a person trainer, group fitness, food app, workout app previously? *
Do you currently use a food tracker and step counter? If so which ones? *
What do you typically eat in a day? *
How many steps do you take a day?  *
Is your job: *
What are foods you like? Give me 3 proteins, carbs and fats you love. *
What foods do you dislike? *
How much caffeine and alcohol do you consume a day?  *
Do you smoke? If so what and how often?  *
Do you have any health issues I need to be aware of? *
What supplements and vitamins are you taking?  *
What is your 3 month, 6 month and 1 year goal?  *
How ready are you to commit to your health and wellness? *
Age and DOB *
Height *
Weight *
Gender *
How many days a week can you commit to a fitness program *
Would you be working out at home or at a gym? *
What equipment equipment do you have access to?  *
What is your fitness level? *
How would you like your weekly check in *
Do you have any injuries I need to be made aware of? *
Are you currently taking any medications? If so what is it and what is it for?  *
How many hours of sleep do you average a night?  *
Do you have any questions for me?  *
I know this is scary but remember this is journey we are on together! Through all the ups and downs we will be doing together! Thank you for considering Samantha Sears Fitness!  *
A copy of your responses will be emailed to the address you provided.
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