Vivo Completo Roadmap Questionnaire
Email *
Today's Date *
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Name (First, Last) *
Date of Birth *
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Age *
Address *
Cell Phone Number *
Preferred Form of Contact? (Check all that apply) *
Required
Occupation *
Work Physical Activity Level *
If we were meeting one year from today—and you were to look back over the last year to today—what has to have happened during that period for you to feel happy about your progress? Please, write a "book" here... the more detailed the better! *
If we could figure this out, what value will this bring to your life? What doors will it open? How will your life be better? *
How will we know we are on track (what can we measure) along the way? *
How important is building muscle, to you, on a scale of 1-10 (not important – extremely important) *
How important is gaining strength, to you, on a scale of 1-10 (not important – extremely important) *
How important is dropping weight/body fat, to you, on a scale of 1-10 (not important – extremely important) *
How important is improving cardiovascular endurance, to you, on a scale of 1-10 (not important – extremely important) *
How important is sweating during a workout, to you, on a scale of 1-10 (not important – extremely important) *
How important is improving your overall health, to you, on a scale of 1-10 (not important – extremely important) *
How important is looking better, to you, on a scale of 1-10 (not important – extremely important) *
How important is variety, to you, on a scale of 1-10 (not important – extremely important) *
On a scale of 1-10, how do you feel about pushing through pain/discomfort? 1 = “I stop at the first sign of anything feeling at all off." 10 = “No pain, no gain!” *
Have you ever worked with a trainer or done instructor led fitness before before? *
If yes, what have you done? (1-on-1 Personal Training, Small Group Personal Training, CrossFit, Spin, OrangeTheory, Yoga, ...)
What have you been doing most recently to try and accomplish your health/fitness/performance goals? *
Tell us a little about your likes/dislikes and what’s worked for you in the past/maybe not worked so much in the past: *
What have been your biggest struggles when it has come to accomplishing your health/fitness/performance goals—currently and/or in the past? *
On average, how many hours of sleep do you get each night? *
Do you sleep through the night? *
Do you wake up feeling rested/energized? *
Do you struggle with energy throughout the day? *
How do you feel like you're currently doing with your nutrition? *
How would you describe your overall stress levels? *
Have you EVER suffered from or been diagnosed with any of the following? (check all that apply) * *
Required
Any other injuries/concerns? (nothing is too small) *
Please list any surgeries (dates/types): *
Do you smoke? *
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by your doctor? *
Do you feel pain in your chest when you do physical activity? *
In the past month, have you had chest pain when you were not doing physical activity *
Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing drugs (i.e. water pills) for your blood pressure or heart condition? *
Do you know of any other reason why you should not do physical activity? *
Are you taking any medications? *
If yes to medications, please list:
If my health should change so that I could answer yes to any of the above yes or no questions and medications during our time working together, I understand that I am responsible for informing Vivo Completo, LLC * *
How would your best friends describe you? *
Emergency Contact (name, relationship, phone number) *
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