Fitness & Health Survey

Thank you for your trust. All information will be treated confidentially.

 

  Date:
  Full Name:
  What is your Current Fitness Level?:  Beginner
 Intermediate
 Advanced
  How many times a week do you exercise?:
  Where do you exercice?:
  When do you exercice:  Morning
 Afternoon
 Evening
  Describe what Type of exercise?:
  Have you tried a fitness/weight loss program:  Yes
 No
  What failed?:
  What worked?:
  Describe your physical weakness:
  What body part become fatigued first?:
  Short term goals:
  Long term goals:
  Favorite Foods?:
  Least favorite foods?:
  Have you ever tried dieting before?:  Yes
 No
  Explain ::
  What failed?:
  What succeeded?:
  How many meals do you eat a day?:
  At what time is your first meal,?:
  At what time is your last meal:
  How many times a day do you eat fruits?:
  How many times a day do you eat vegetables?:
  What is your average day like, time of meals?:
  When do you feel the most tired?:
  You phone:
  Your E-mail:
Please click on the Submit button to submit the form details.
 

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