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2017
January
C
Client Questionnaire
Client Questionnaire
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Questions marked with a
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Contact Information
First Name
:
Last Name
:
*
Phone
:
*
Email Address
:
What services do you have interest in?
Coaching
Workout Plan
Nutrition Program
Age:
Gender:
Current Height:
Current Weight (lbs):
*
Current Height?
*
Current Weight (lbs.)?
*
What are your health and fitness goals (Select all that apply)?
Decrease Body Fat
Increase Strength and Power
Reduce Stress
Improve Athletic Performance
Tone Muscles
Maintain Current Health
*
What is keeping you from achieving your Health and Fitness goals (Select all that apply)?
Lack of Motivation
Too little time for exercise
Not knowing what to do
Hitting a plateau
Please select all activities/exercises you are comfortable with attempting, or you have done before (Select all that apply)?
Running/Jogging
Walking/Hiking
Weight Lifting (Free Weights)
Circuit Training/Group Exercise Classes
Biking
Swimming
Yoga
KettleBells
What time of day would you prefer to workout?
Do you have a gym membership? If not, do you own any exercise equipment? It's okay if you don't :)
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