New Client Questionnaire
Name Fill in your first and last name
How would you rate your current fitness or rehabilitation program?
What would you like to see more and less of in your new program?
(ie: stretching, cardio, strength training, etc.)
Please list in order of priority, the health, fitness and functional goals you would like to achieve in the next 3-12 months?
How can I help you? Check all that applies:
lose body fatdevelop muscle tonerehabilitate an injuryStart an Exercise programDesign a more advanced programbalancefunmotivation
What are the obstacles that you feel get in the way of your health or fitness program?
(i.e. not training consistently, upcoming vacations, busy at work, not motivated)
Besides the questions you answered on your health history, is there anything else that I need to know about your body for movement purposes?
Please enter any two digits *Example: 12
This box is for spam protection - please leave it blank: