Exercise History & Attitude Questionnaire
This form is to help me get a better idea of how you feel about reaching your fitness goals. Although, most of these questions are not required, it is best to answer them all to help with the process of customizing your exercise program, and to stay in contact with you throughout your progress.
Full Name *
Your answer
Your Best Phone Number To Be Reached
Your answer
Email Address
Your answer
Age *
Your answer
Height *
Your answer
Current Weight *
Your answer
Have you ever participated in any exercise program in the past? *
If yes, please explain:
Your answer
Have you ever had any negative feelings toward or have you had any bad experiences with physical activity programs? *
If yes, please explain:
Your answer
When you exercise, how important is competition?
Not important.
I enjoy a friendly competition.
Characterize your present cardiovascular capacity (are you in shape?) *
I'm out of shape
I'm in shape
Characterize your present muscular capacity: *
Least Capacity.
Great capacity.
Characterize your present flexibility: *
Least capacity.
Great capacity.
Do you start exercise programs but then find yourself unable to stick with them?
How much are you willing to devote to an exercise program? *
Minutes per day, days per week.
Your answer
What types of exercises interest you? *
Check all that apply.
Required
By how much would you like to change your current weight? *
Whether you want to gain weight, or lose weight, in the form of the number of pounds.
Your answer
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