Initial Assessment

Welcome! This questionnaire takes about 5-10 minutes, and is designed to give me background on your starting point and goals. This will assist me in creating a plan catered just for you. All answers are confidential. If you're unsure of any questions just give them your best shot.  
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?
What are the obstacles that have held you back from changing these things?
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?
Training
Where will you train?
Check all that apply
What equipment do you have access to?
Check all that apply
What is the minimum number of times that you can commit to training per week?
What is the minimum duration of each session that you can commit to?
What is your current level of training experience?
Would you say you have knowledge and experience in the following exercises:
Would you say you have knowledge and experience in the following exercises:
Barbell Squat
Deadlift
Lunge
Barbell Bench Press
Pull-up
Plank
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)
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 many units of alcohol do you consume per week?
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 *
Please state your level of experience with the following exercises
Barbell Squat