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5th June 2025
Fitness and Health Assessment
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Please enable JavaScript in your browser to complete this form.
Reasons for getting in shape
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Why do you want to get in shape?
Desired outcomes
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What are you trying to achieve?
Goals
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What are your Short & Long-term goals?
Duration
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How long has this been a goal for you?
Motivation
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What is most important to you about achieving this goal?
Obstacles
*
What has prevented you from achieving it in the past?
Current Actions
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What are you currently doing to reach your goals?
Expert help
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Do you think you’d reach your goals faster with an expert helping you?
Current Actions
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Is it more important to lose the weight quickly or that it’s permanent?
Injuries or Health Issues
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Do you have any existing injuries or health concerns?
Timeline
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How soon do you want to achieve your goals?
Commitment Level
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On a scale of 1 to 10, how badly do you want to achieve your goals?
Commitment Level
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Are you committed to working out at least twice a week?
Nutrition
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What does your current food intake look like?
Hydration
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What kinds of liquids do you usually drink?
Your Height
*
Basic Stats
Your Weight
*
Basic Stats
Your Resting Heart Rate
*
Basic Stats
Your Age
*
Basic Stats
Stress & Mental Health
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Do you eat more or less when you’re stressed?
Stress & Mental Health
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Do you worry over job, income or money problems?
Stress & Mental Health
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Are any relationship causing you stress?
Stress & Mental Health
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do you often feel anxious?
Stress & Mental Health
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do you often get upset when things go wrong?
Stress & Mental Health
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do you lash out at others?
Stress & Mental Health
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do you feel isolated or lonely at times?
help Level Health
Stress & Mental Health
*
do you take any form of medication prescribed by a physician directly or indirectly related to stress in your life or for psychology disorder?
Submit
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