Thank you for purchasing personal training

Thank you for purchasing personal coaching program. Please fill in the Fitness and Nutrition assessment questionnaire below:

CONTACT & BASIC HEALTH INFORMATION:

MF
Weight (lbs): Body Fat%
Weight (lbs): Body Fat%

HEALTH HISTORY INFORMATION:

YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
HASHRAFSA

If you answered “Yes” to any of the questions above, please initial and answer the following question:

YesNo

FITNESS INFORMATION:

YesNo
YesNo
YesNo
YesNo


YesNo
Not ActiveModerateVery Active
PoorFairGoodGreat

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