LIFESTYLE EVALUATION

Name:

Job Title:

Company Name:

Email Address:

Address:

Mobile Phone:

Married or Single

Do you have children under the age of 16 living in the home with you?

Occupation

Are you involved in any activities outside of work? (Church, School, Organizations)

What days and times are you available to exercise?

Height?

Weight?

Age?

Have you ever played a sport? What sport and how long did you play?

Are you currently physically active/exercise? What activities are you involved in?

On average how often do you exercise?

How long have you been consistent and involved in some form of physical activity?

How many meals do you eat daily? Including snacks.

How much water do you drink daily? How many bottles?

How much sleep do you average per night?

Do you take a multivitamin or any other supplements?

Do you have any health concerns?

Do you take any medication?

Do you have any joint or muscle concerns?

Do you have gym equipment, a gym membership, or access to a fitness facility?

Have you ever worked with a trainer? How was that experience?

What are your general feelings towards Exercise?

What is your preferred exercise intensity?

What is your favorite form of exercise?

What are your immediate health and fitness goals?

Do you have a deadline for achieving your health and fitness goals?

Have you created a budget for your health?

Thank You for Completing Your Lifestyle Evaluation.