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Intake Questionnaire
Personal Details
*
*
Sex
A
Male
B
Female
C
Other
Age
*
Height
*
*
Weight
*
*
Body Composition
History
Goals
Tell me about your goal.
*
Why do you want to achieve this goal?
*
How long have you wanted to achieve this goal?
A
< 1 Month
B
1-6 Months
C
6-12 Months
D
> 1 Year
Have you tried to achieve this goal in the past and failed?
*
A
Yes
B
No
C
Tried and succeeded
How long have you been training in general?
*
A
< 1 Month
B
1-12 Months
C
1-5 Years
D
5+ Years
E
Never
How long have you been training specifically for your goal?
*
A
< 1 Month
B
1-12 Months
C
1-5 Years
D
5+ Years
Tell me more about your fitness journey.
Have you ever tracked your food?
*
A
Yes, currently tracking.
B
Yes, in the past.
C
No.
D
What are you talking about?
Have you ever tracked your workouts?
*
A
Yes, currently tracking.
B
Yes, in the past.
C
No.
D
What are you talking about?
Have you ever worked with a coach or trainer?
*
A
Yes, currently.
B
Yes, in the past.
C
No.
Submit
