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FIT180 First Assessment

Please fill out this assessment so I can get to know you a little better and see where we need to focus during these next 12 weeks! You'll also be taking this again at the end of the 12 weeks to re-assess where you are. 

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Question 1 of 35

What's your name?

Question 2 of 35

What's your age?

Question 3 of 35

What's your mailing address?

Question 4 of 35

What is your height?

Question 5 of 35

What are your top 3 fitness goals?

(Select all that apply)
A

Appearance (aesthetics)

B

Cardiovascular endurance

C

Fat loss

D

Flexibility

E

Health (general)

F

Muscular definition

G

Muscular strength/power

H

Self-esteem or confidence

I

Stress reduction

J

Toning and shaping

K

Weight loss

Question 6 of 35

What do you weigh right now? If you know your body fat % or muscle mass, let me know those as well. If not, no worries!

Question 7 of 35

What's your target weight?

Question 8 of 35

What size jeans do you wear?

Question 9 of 35

What's your target jean size?

Question 10 of 35

What do you do for a living (job)? What’s your lifestyle like? (from morning to night, give me an example of your day to day routines)

Question 11 of 35

What are a few obstacles that might stand in the way of you reaching your goals?

Question 12 of 35

How many ounces of water do you drink daily?

A

16

B

32

C

64

D

80

E

100+

F

I don't know

Question 13 of 35

How many days per week do you eat out?

Question 14 of 35

Do you drink alcohol? If so, how many glasses per week?

Question 15 of 35

Are there any foods you don't like?

Question 16 of 35

Do you have any food allergies? If so, please list below.

Question 17 of 35

Are you taking any medications or supplements? If so please list below.

Question 18 of 35

How many days per week do you workout? Or how many days per week will you commit to working out?

Question 19 of 35

Which days can you commit to working out?

Question 20 of 35

Do you have a steps tracker? (apple watch, fitbit, etc.)

A

Yes

B

No

C

Other

Question 21 of 35

What equipment do you have access to?

(Select all that apply)
A

Free weights (dumbbells/barbells)

B

Cable weights

C

Resistance bands

D

Bosu ball

E

Stability ball

F

Kettlebells

G

TRX bands

H

Battle ropes

I

Gym (all of the above)

Question 22 of 35

Do you have any medical conditions, injuries or areas of pain? If so please be specific.

Question 23 of 35

Rate your current level of confidence about your body on a scale from 1-5 (1 being not confident at all and 5 being VERY CONFIDENT)

Question 24 of 35

On a scale of 1-10, rate your energy level. (10 being I feel great)

Question 25 of 35

On a scale of 1-10, rate your overall quality of sleep. On average, how many hours per night? (10 being I feel great)

Question 26 of 35

On a scale of 1-10, how stressed are you on a daily basis? (10 being I feel great)

Question 27 of 35

On a scale of 1-10, rate your mental focus and clarity (brain fog, forgetting things, trouble concentrating). (10 being I feel great)

Question 28 of 35

On a scale of 1-10, rate your digestive health (bloating, belching, gas). (10 being I feel great)

Question 29 of 35

On a scale of 1-10, rate your skin condition (dry, acne, breakouts, oily). (10 being I feel great)

Question 30 of 35

On a scale of 1-10, rate your pain (headaches, joint pain, muscle aches). (10 being I feel great)

Question 31 of 35

Tell me about a time when you worked with a coach you liked. What did you like about it?

Question 32 of 35

Tell me about a time when you worked with a coach you didn't like. What didn't you like about it?

Question 33 of 35

How much do you make on a monthly basis? (average month)

Question 34 of 35

How many hours do you work per day? Of those hours, how many of them are productive?

Question 35 of 35

Is there anything else you want me to know?

Confirm and Submit