LIFESTYLE QUESTIONNAIRE

Answer the following questions to the best of your ability and ensure you answer every question on the form below. This information will provide us with the information needed to create a personalized training program just for you. After completing your answers you will find a submit button at the bottom of the page, just click the button and it will be sent to us automatically.

Name:

Email:

How would you describe your present state of health? :

Do you have any medical Issues that you take or have taken medication for? If so explain::

Do you or have you had any injuries or ailments that may affect your ability to perform certain movements? If so explain::

Please Indicate Your: Height: Weight: Age:

Are you or have you been a smoker?:

How often do you take part in physical activity? :

Are you self taught or do you have formal education on weightlifting exercises? (Explain if needed):

How many days/week can you dedicate to exercising?:

What are your specific fitness goals? (give as much detail as possible):

What time frame are you setting to achieve these goals? (if ongoing just indicate ongoing): :

What are your favorite types of activities/sports? :

Any other information you feel may be relevant in designing a workout regiment for you? :