DMB Coaching physical activity readiness questionnaire.
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Date of birth
WhatsApp Phone Number ( if used )
Instagram Username ( if used )
Height (please state which metrics you are using)
Current weight - (Kg's or Lb's) Please state which
What is your 12 week fitness goal / goals?
What is your current occupation? is it quite active or sedentary? this is to gauge activity levels.
Can you commit to physical exercise 3 days per week or more? please state how many days ( be realistic )
What time of the day best suits you to exercise
What days of the week are you available to train?
Do you do any other physical exercise such as swimming, sports etc.. if so please give details and what days these occur.
Type of gym you will be working from?
Home gym ( no equipment )
Home gym ( Limited equipment )
Please give details of what equipment you have available to you if not using a full size gym
Describe your current daily activity level ( including work physical activity)
What are your main reasons for starting a fitness program? Tick as many as needed
General health and fitness
weight / fat loss
Improve self esteem
Do you have any food allergies? If yes please list.
Do you have access to a weighing scale and a food weighing scale?
Have you had any major illness or injuries in the past 5 years? If yes please give details
Are you on any medication or treatment for any diagnosed medical condition?
Please indicate whether you experience any of the following symptoms during exercise
Unusual shortness of breath with very light exertion
Pain, pressure, heaviness or tightness in your chest area
unexplained pain in the abdomen, shoulders or arms
Dizzy spells or episodes of fainting
Lower leg pain during walking that is relieved by rest
experience palpitations or irregular heartbeats
Females - Are you currently pregnant or have given birth in the past 6 months?
Please list 2-3 regular meals you would consume for breakfast lunch and dinner each.
How do you generally eat? example, not very hungry in mornings, tend to have light lunch and large dinner, or super hungry in mornings, tend to skip lunch and eat snacks and then large dinner at night etc. This is so I can best adjust meal sizes in your meal plans.
Do you have any injuries, limited range of motion or discomfort whilst exercising? If yes please explain
On average - how often do you consume alcohol each week? Is it in low amounts or does it usually result in hangovers?
What date would you be potentially wanting to begin?
Thank you for taking the time to answer the questions in this form.
A copy of your responses will be emailed to the address you provided.
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