FA Questionnaire page 2

Fitness History

* Indicates required field

Name *

First

Last

Rate yourself on a scale of 1 – 5 (1 indicating the lowest value).

How would you rate your current cardiovascular capacity?. *

5 - My heart is like an athlete! 4 - I can run and talk to a friend. 3 - I can exercise for 30 minutes non stop. 2 - I can walk, running I lose my breath 1 - I get out of breath going up small steps

How would you rate your muscular capacity? *

5- I'm a gym meat-head! But I love it! 4- I do resistance training 3+ times a week 3- I lift heavy objects all day 2 - my muscles are very weak 1 - I barely move all day

Do you currently exercise? *

Yes No

If yes, how often? *

Do you find yourself starting an exercise program then unable to stick with it? *

Yes No

If yes, what is your reason for stopping? *

Do you have any joint mobility issues? *

Yes No

If yes, explain. *

Have you had any recent surgeries? *

Yes No

If yes, explain *

Are there any exercises you cannot perform? If yes, Explain.. *

What is your 6 week Fitness Goals? *

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