Initial Assessment

Welcome! This questionnaire takes about 10 minutes and is designed to give me some more background on you. Answers are confidential, and if you're unsure of anything just give it your best shot. 

Info and contact
Name *
Name
In the format of dd-mm-yyyy
Do you smoke/vape?
Your goals
What would you like to get from Training? *
You can tick as many as apply
What do you expect?
What's worked for you in the past?
If so, what?
Household
Who makes up your household?
Check all that apply
Right now, how much do the people and things around you support health, fitness, and/or behaviour change?
Diet and nutrition
Right now, how would you rate your overall eating / nutrition habits?
How would you rate your understanding of food/nutrition right now? (ie. what the main nutrient types are, what foods are healthy, what calories are etc.)
How do you feel about preparing and cooking your own meals?
How often do you eat out/have takeaways or readymeals, including lunch at work?
Who does most of the grocery shopping in your household?
Check all that apply
Who decides on most of the menus/meal types in your household?
Check all that apply
Who does most of the cooking in your household?
Check all that apply
How often do you consume alcohol?
Activity
How many hours per week are you regularly active in sports and/or exercise?
On average, how many hours per day are you active in other ways?
(e.g., housework, walking to work or school, home repairs, moving around at work, gardening)
What’s your health like?
How would you rate your overall health right now?
Have you been diagnosed (currently or in the past) with any significant medical condition(s) and/or injuries? *
If yes, please give details
Right now, do you have any specific health concerns, such as illnesses, pain, and/or injuries? *
If yes, please give details
Right now, are you taking any medications, either over-the-counter or prescription? *
Stress and recovery
Given all the demands of your life, what is your typical stress level on an average day?
On average, how many hours per night do you sleep?
How ready, willing, and able are you to change?
Right now, I'm READY to change my behaviours and habits
I'm WILLING to change my behaviours and habits
I'm ABLE to change my behaviours and habits
DISCLAIMER *