Fitness Consultation Questionnaire

Name *

Age *

Height *

Weight *

Telephone Number

Work Phone

Email address *

Fitness Goals: Lose Weight, Lose Fat, Increase Muscle Weight, Reshape and Tone, Increase Endurance, Improve Health, Feel Better, Other *

How many days per week do you exercise? *

How many days per week do you perform cardio? *

What kind of cardio, if any, do you perform: Walking, Biking, Jogging, Treadmill, Ellipitcal, Stairmaster, Upright Bike, Other *

How many minutes do you perform cardio? *

Do you know what your target heart rate is? *

Yes No

Do you weight train? *

Yes No

How many days a week do you weight train? *

Explain your weight training workouts. *

Which body parts do you train together? *

Do you participate in any other forms of exercises: Pilates, Yoga, Aerobics, Other? *

Are you engaged in any other forms of physical activity? *

Do you eat breakfast? *

Yes No

How many meals do you eat daily? *

Do you snack throughout the day? *

Yes No

At what times do you eat your meals?

How much water do you drink daily? *

Do you take vitamins/ supplements? *

Yes No

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