Fitmotive Member Questionnaire

First name

Last name

Phone

Who is your coach?

How Did You Hear About Us?

If someone referred you, please leave their name here.

Birthday

Year

Month

Day

City

Province/State

Height

Weight

Age

Goal Weight (If you have one)

How active are you?

Tell us a bit about yourself

What's your daily schedule like?

What's your work environment like?

Tell us about any previous fitness experience

Please list any food allergies, dislikes, restrictions or is there any food that you cannot digest well if you have any?

What are some foods you enjoy & can digest well (if you know)?

What are some foods you can tolerate & eat little of?

What is your current diet like?

Describe your current nutrition as best as you can.

Do you currently own a gym membership?

If you have a gym membership, or are going to get one, which gym do you or will you be working out at?

If you prefer at-home workouts, what equipment do you have available to you to use.

Add pictures of your equipment below (if doing home workouts)

Are you willing to workout 5-6 days per week?

When do you prefer to exercise?

Is there any area's your having trouble improving or would like to work on most?

Currently, what's your biggest challenge(s) in reaching your goals?

Do you have any current medical conditions or injuries? If so please explain.

What is your ultimate goal & destination to reach with your fitness coaching?

Why do you want to make this change?

Why is this something that is important to you?

Anything you'd like to add

Please include anything you would like to add or make sure your coach knows before starting up.