Wellness Intake Form
Wellness Intake for Intro Offer
Email address *
Welcome! and what is your name? *
Your answer
Where did you hear about our intro offer? *
Required
What made you decide to take our intro offer? *
Your answer
Why today (and not 1, 3, 6, etc months ago...or not 1, 3, 6 etc months later)...why now? Did something happen to make you take action now? *
Your answer
How do you feel about the possibility of starting/changing/continuing exercise? *
Required
Have you taken a class at StudioTimeOut yet? *
If you HAVE taken a class at the studio, which class, how did it go for you....did it meet your needs? Did you like it? Do you wish something was different about it?
Your answer
What are you hoping to get from exercise? *
Required
Tell me more about your wishes/goals for exercise and health. Anything specific you are wanting in terms of physical, mental or lifestyle goals/changes?
Your answer
Have you tried other studios, gyms, fitness facilities? *
Required
If you have NOT been to a gym or studio, what has stopped you?
Anything additional you'd like to share about why you have never gone to a gym or studio before?
Your answer
If you HAVE tried a gym or studio, did it work for you or not? *
Required
Anything you want to add/explain about your past experiences going to gyms or studios?
Your answer
Tell me about the time you have for exercise *
Required
Anything you want to explain more about your available time for exercise?
Your answer
Do you have support for you exercising (spouse, kids, parents, neighbors, roommates, etc)? *
Required
Anything else you want to explain about who is or is not supporting you in your efforts to exercise and/or get healthy?
Your answer
Everyone has something with the potential to stop them.What obstacles do you see standing in your way? *
Required
How long has it been since you've felt like you were in ideal shape? *
Required
Anything else you'd like to add about when you've been in shape?
Your answer
If you were in good shape in the past, what were you doing then and who were you doing it with?
Your answer
If you stopped....what triggered you to stop?
Your answer
How long have you been thinking about change or reaching your fitness goals? *
Your answer
How serious are you about conquering this and making it happen? *
Not at all
completely serious
If not a "10" why not?
Your answer
What joint problems do you have? *
Required
Do you have any of these? *
Required
Anything you would like to add about physical issues affecting your ability to exercise?
Your answer
If you can imagine what your life would look like when you achieve your goals, how will you feel? How will your life change? What will you do? *
Your answer
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