Online Consult

Name(required)

Email(required)

Phone

How did you hear about Fit For Everyone?(required) (PLEASE SELECT) Internet Search True Local Friend

Age(required) (PLEASE SELECT) < 21 22 - 35 36 - 44 45 - 55 >55

Is your job physical or sedentary?(required) (PLEASE SELECT) Physical Sedentary

How long have you considered and exercise program?(required) (PLEASE SELECT) < 1 month < 6 months > 6 months

What has kept you from staring an exercise program?

Are you currently exercising and/or playing a sport?(required) (PLEASE SELECT) I play a sport I Exercise I do both I do neither

Are you currently on a diet or watching your eating habits?(required) (PLEASE SELECT) Yes No Sort of

I would like to reduce body fat(required) (PLEASE SELECT) Important to me Somewhat important to me Not important

I would like to improve my fitness for a sport(required) (PLEASE SELECT) Important to me Somewhat important Not important

I require rehabilitation(required) (PLEASE SELECT) Important to me Somewhat important Not important

I want to increase my endurance levels(required) (PLEASE SELECT) Important to me Somewhat important Not important

I want to reshape my body(required) (PLEASE SELECT) Important to me Somewhat important Not important

I would like to better manage my stress levels(required) (PLEASE SELECT) Important to me Somewhat important Not important

I want to improve muscle tone(required) (PLEASE SELECT) Important to me Somewhat important Not important

I want to improve my strength(required) (PLEASE SELECT) Important to me Somewhat important Not important

I want to increase muscle mass(required) (PLEASE SELECT) Important to me Somewhat important Not important

When would you like to acheive youre results by?(required)

How important is to you to achieve your goals?(required) (PLEASE SELECT) 5/5 Critical 4/5 Very important 3/5 Important 2/5 Would like to 1/5 See how I go

How many hours per week do you have available for exercise?(required) (PLEASE SELECT) <2 hours 2 hours 4 hours 6 hours 8 hours >8 hours

My family and friends support me in a training program(required) (PLEASE SELECT) Supportive Somewhat supportive Not supportive

Is there anything preventing you from commencing an exercise program today?(required) (PLEASE SELECT) Yes No

If yes please provide a reason

Do you or have you ever suffered from Arthritis?(required) (PLEASE SELECT) Yes No

Do you or have you ever suffered from Asthma?(required) (PLEASE SELECT) Yes No

Do you or have you ever suffered from Diabetes?(required) (PLEASE SELECT) Yes No

Do you or have you ever suffered from Epilepsy?(required) (PLEASE SELECT) Yes No

Do you or have you ever suffered from a Heart condition?(required) (PLEASE SELECT) Yes No

Do you or have you ever suffered from High or Low Blood Pressure?(required) (PLEASE SELECT) Yes No

Do you or have you ever suffered from Back Pain?(required) (PLEASE SELECT) Yes No

Do you or have you ever suffered from Chest Pain?(required) (PLEASE SELECT) Yes No

Have you been pregnant recently?(required) (PLEASE SELECT) Yes No

Have you incurred any major injury that would affect you in exercising?(required) (PLEASE SELECT) Yes No

Are there any Physical or Mental conditions that may impact your ability to exercis(required) (PLEASE SELECT) Yes No

Do you eat Junk Food?(required) (PLEASE SELECT) Yes No

Do you smoke?(required) (PLEASE SELECT) Yes Socially No

Do you drink alcohol?(required) (PLEASE SELECT) Daily Weekly Occassionaly No

Submit

Δ

Like this:

Like Loading...