Welcome to the first step in becoming your best self.
YOU are unique, and we believe your Lifestyle, Fitness, and Nutrition Program should align with your specific needs, goals, limitations, schedule, and realities, to best support your success and longevity.
Please take the time to answer these questions with as much honesty and detail as possible. The more you're willing to share with us, the better it will allow us to understand where you currently sit in your journey so we can align our services appropriately to ensure you succeed.
* Required
How did you hear about us?
*
Social Media
Google
Yelp
Friend/Word of mouth
Walk by/Storefront
Other
First name
*
Your answer
Last name
*
Your answer
Email
*
Your answer
Phone
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
What goals are you seeking to achieve via our services?
*
Increase overall health & wellbeing
Improve sleep
Improve nutritional practices
Improve overall lifestyle habits
Improve overall fitness levels
Improve strength
Improve flexibility
Improve endurance
Improve aesthetics
Increase energy levels
Finding alignment and balance with my realities and workouts
Becoming my best self
Other:
Required
Please explain what a typical day looks like for you (ie: wake time/sleep time, breakfast/lunch/dinner, work/career (day shift, night shift, swing shift, work from home...etc), stress levels, do you sit, drive, stand, move...etc., long hours, physical demands, sedentary....etc):
*
Your answer
Please describe your current eating routine/nutrition habits (How many meals per day do you consume? Are they whole food meals, shakes/smoothies, pre-made/pre-packaged, eating out/delivery, do you take into consideration the "what and why" you choose to consume for each meal?, etc...):
*
Your answer
Please describe your fitness/athletic history (any and all sports you've played since youth, any and all workout/fitness programs/routines/gyms you have tried/completed and how you felt about each them (loved, hated, indifferent...etc)):
*
Your answer
How many days per week do you feel your current lifestyle and realities will allow for your workout program/routine?
*
Your answer
Do you have any medical conditions we should be aware of?
*
Yes
No
Medications that could impair your; motor skills, mental clarity, and/or emotional state?
Surgeries
Injuries
Hardware that could impact range of motion and/or movement mechanics
Yes
No
Medications that could impair your; motor skills, mental clarity, and/or emotional state?
Surgeries
Injuries
Hardware that could impact range of motion and/or movement mechanics
If you answered "Yes" to any of the items above, please provide detail:
Your answer
Please tell us about your sleep habits (are you aware of your quality of sleep? how many hours do you sleep per night? do you feel your daily lifestyle habits currently support quality sleep?.....etc.):
*
Your answer
Please tell us about your hydration practice (are you aware of how much water you consume per day?, are there specific obstacles that you feel detour you from consuming water on a steady, consistent basis each day?, is consuming enough water challenging for you?...etc.)
*
Your answer
Please tell us where you prefer or plan to workout?
*
"Onsite" at The C5 Facility
"Hybrid" (C5 Facility & at home or outdoors)
"Remote" (either another facility, or at home)
Other:
Required
Please tell us your current top 3 values/priorities in life that drive your daily decisions (ie: family, career, fitness/health.....etc.):
*
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of C5 FIT.
Report Abuse
Forms
