Fitness Assessment Form
INSTRUCTIONS...
Fill out All of the questions below. It is IMPORTANT that you are detailed in your answers.
This will help give you the best assessment possible which will lead to BETTER RESULTS.
Email address *
Name *
Your answer
City and State *
Your answer
Age *
Your answer
Gender *
Required
Height *
Your answer
Weight *
Your answer
Goals (Please be specific) *
Your answer
How committed are you to achieve this goal *
Barely
I will do what it takes
Are you currently exercising? If so, what are you doing? (Please be very detailed) *
Your answer
Are you a member of a gym or have access to exercise equipment? (Please be Specific) *
Your answer
Can you commit to a workout 3-5 days a week (No workouts will be longer than an hour) *
Required
Are you willing to send daily reports of your eating and exercise routines (should take about 5 minutes of your time) *
Required
Do you have any health issues that may prevent you from doing certain exercises? (Please be specific) *
Your answer
How far can you jog without stopping? *
Your answer
Please provide me with a list of what you have eaten and drunk in the past 3 days. (Please be specific as possible) *
Your answer
What type of information and updates would you like to receive from an email list (Please be specific so we can help you best)
Your answer
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