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HEALTH AND FITNESS QUESTIONNAIRE
This intake form allows us to gather the critical health and personal information needed to plan for your upcoming meal and workout schedules. You are required to complete this form in order for your health project to start.
Personal information
First Name
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Required
Last Name
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Required
Phone Number
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Required
Date of Birth
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Required
Email Address
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Required
Home Address
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Required
City | State | Zip
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Required
Gender
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Required
Please upload a photo of yourself
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Required
Click to choose a file or drag here
Size limit: 10 MB
Do you have any special health conditions?
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Required
What is your current body weight?
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Required
What is your desired weight or body goal?
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Required
What is your height?
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Required
What is your current activity level?
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Required
What is your current activity level?
A
Sedentary (mostly sitting)
B
Lightly active (1–2 workouts/week)
C
Moderately active (3–4 workouts/week)
D
Very active (5+ workouts/week)
E
Athlete / intense training
How soon would you like to reach your fitness goal?
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Required
What type of workouts do you enjoy or prefer?
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Required
What type of workouts do you enjoy or prefer?
Do you have any injuries or physical limitations we should consider?
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Required
How would you rate your sleep quality?
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Required
Are you currently tracking your meals or calories?
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Required
Anything else we should know about your body, goals, or lifestyle?
*
Required
Submit
