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Philosophy
Personal Training
App
Clients
Contact
Blog
Log in
Initial Assessment
Welcome! This questionnaire takes about 10 minutes, and is designed to give me some background on your starting point and goals. All answers are confidential. If you're unsure of any questions just give them your best shot.
Name
*
Name
First Name
Last Name
Date Of Birth
In the format of dd-mm-yyyy
Gender
*
Male
Female
Email
*
Mobile
Emergency Contact Name
Emergency Contact Number
Do you smoke/vape?
Yes
No
Your goals
What would you like to get from Training?
*
You can tick as many as apply
Improve fitness
Lose weight/body fat
Maintain weight
Gain weight
Gain muscle
Get stronger
Look better
Feel better
Have more energy
Develop better control of eating habits
Learn about nutrition
Improve athletic performance
Recover from injury
Physique competition/modeling
Other
Of these, which is the ONE most important to you?
What do you expect?
What do you most want to get from me as your Trainer?
What's worked for you in the past?
Have you tried anything in the past to change your habits, your health, your eating, and/or your body?
If so, what?
Which of those things worked well for you? (Even if you might not be doing it right now.)
Which of those things didn’t work well for you?
How, specifically, would you like your habits, your health, your eating, and / or your body to be different?
What are some of the obstacles that have held you back from changing these things?
Household
Who makes up your household?
Check all that apply
Live alone
Spouse or partner
Child(ren)
Other family
Roommate(s)
Pet(s)
Right now, how much do the people and things around you support health, fitness, and/or behaviour change?
Not at all
They have no opinion
A bit
Completely
Diet and nutrition
Right now, how would you rate your overall eating / nutrition habits?
Awesome
Good
OK
Bad
Horrible
Why?
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.)
I'm an expert
I have a good everyday understanding of nutrition
I have basic knowledge
I'm not sure
I don't really understand nutriton
How do you feel about preparing and cooking your own meals?
I never cook meals
I can do the basics
I cook most of my own meals
I love cooking & do as much as possible
How often do you eat out/have takeaways or readymeals, including lunch at work?
Once per week or less
Once or twice per week
Once per day
More than once per day
All my meals
Who does most of the grocery shopping in your household?
Check all that apply
Me
Spouse or partner
Child(ren)
Other family
Roommate(s)
Who decides on most of the menus/meal types in your household?
Check all that apply
Me
Spouse or partner
Child(ren)
Other family
Roommate(s)
Who does most of the cooking in your household?
Check all that apply
Me
Spouse or partner
Child(ren)
Other family
Roommate(s)
How often do you consume alcohol?
Not at all
About once a month or less
About once a week
More than once a week
Daily
Activity
How many hours per week are you regularly active in sports and/or exercise?
None
1-2 hours per week
2-5 hours per week
5-9 hours per week
10+
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)
None
1 - 2 hours per day
2 - 4 hours per day
4 - 8 hours per day
8+
What’s your health like?
How would you rate your overall health right now?
Awesome
Good
OK
Not very good
Poor
Have you been diagnosed (currently or in the past) with any significant medical condition(s) and/or injuries?
*
Yes
No
If yes, please give details
Right now, do you have any specific health concerns, such as illnesses, pain, and/or injuries?
*
Yes
No
If yes, please give details
Right now, are you taking any medications, either over-the-counter or prescription?
*
Yes
No
If yes, please give details
Stress and recovery
In an average week, how many hours do you spend in your main occupation (work/college/parenting etc?)
In an average week, how many hours do you spend travelling and/or commuting?
Given all the demands of your life, what is your typical stress level on an average day?
None
A little stress
OK
Quite a lot of stress
Extreme stress
How do you normally cope with stress?
On average, how many hours per night do you sleep?
4 or less
5
6
7
8
9
10 or more
How ready, willing, and able are you to change?
Right now, I'm READY to change my behaviours and habits
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I'm WILLING to change my behaviours and habits
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I'm ABLE to change my behaviours and habits
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
DISCLAIMER
*
Please recognise that it is your responsibility to work directly with your health care provider before, during, and after seeking nutrition and/or fitness consultation. Any information provided is not to be followed without prior approval of your doctor. If you choose to use this information without such approval, you agree to accept full responsibility for your decision.
Thank you for your submission, we'll be in touch!