Pre-Training Questionnaire Set your intention for your fitness and nutrition goalsUse the form below to review your fitness and nutrition goals. Click “submit” when you have finished. Name * First Name Last Name Email * Program * Custom Personal Training Plan Nutrition 101 Beginners Guide to Weight Loss Strength Training for Weight Loss Hot Mama! Semi-Private Group Training What are your goals for fitness and wellness? Check all that apply Weight Loss Fat Loss Toning Build Muscle Increase Strength Increase Endurance Increase Power Increase Muscle Size (Hypertrophy) Improve Cardiovascular Fitness Improve Diet General Health & Wellness Improve Flexibility Improve Balance Improve Mobility Improve Sports Performance Combat Effects of Aging Manage Illness or Health Condition Other If you selected "Other" above, please describe your goal below: How fit do you feel now on a scale of 1 to 10? * 1 being "I am not active at all" and 10 being "I am very fit and active" 1 "I am not active at all" 2 3 4 5 6 7 8 9 10 "I am very fit and active" Daily Activity Do you wear a fitness tracker or activity tracker? * Such as a step tracker, FitBit, or Apple Watch Yes No If you wear a fitness tracker, what type? For example, Apple Watch, Fitbit, etc. If you wear a fitness tracker, how many steps or miles do you walk on an average day? How many hours per week do you engage in light sports activities (doubles tennis, softball, volleyball, social dancing)? How many times per week do you engage in vigorous exercise? How many minutes do you spend each time? How many hours per week on average do you perform household chores (laundry, cleaning, cooking)? How many hours a week do you tend a garden or lawn? Do you care for small children? Yes No Caretakers of small children: Please check all that apply of the following: I am a caretaker who assumes primary responsibility for a preschool child Child and Caretaker at home all day Child spends half day in day care Child spends full day in day care Worklife Select the choice below that best describes your job. I have a desk job My job is physically demanding (lifting, carrying, shoveling, climbing) My job is a mixture of activity and seated work How many hours a day does your job require you to be standing, but moving around very little? How many hours a day does your job require that you be on your feet and moving? Count actual time moving only. If you have a desk job, how many times per hour do you leave your desk (running errands, greeting visitors, attending meetings, etc.)? If your job is physically demanding, how many hours a day are you involved in vigorous activity? Stress & Self-Care On a scale of 1 to 10, how would you rate your current stress level on an average day? * 1 "Stress free--I'm totally relaxed!" 2 3 4 5 6 7 8 9 10 "Stressed out--on the verge of a nervous breakdown" How often do you do things to relax and de-stress? What do you do to relax and de-stress? Sleep & Rest How many hours per night do you usually sleep? On a scale of 1-10, how would you rate the average quality of your sleep? 1 "Very poor--I hardly ever feel well-rested" 2 3 4 5 6 7 8 9 10 "Great! I wake up fresh as a daisy!" Do you have a bedtime routine? What does it include? Thank you!