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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