Name
*
First Name
Last Name
Email
*
Message
Age
*
Height
*
Weight
*
Health & Medical History
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1. Do you have any chronic health conditions (e.g., diabetes, heart disease, asthma)?
2. Are you currently taking any medications?
3. Do you have any injuries or physical limitations?
4. Have you had any surgeries in the past 5 years?
Lifestyle & Habits
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5. How would you rate your overall stress level?
6. How many hours of sleep do you get per night on average?
7. Do you smoke?
8. How often do you consume alcohol?
9. Do you follow any specific diet or eating plan (e.g., vegetarian, keto, intermittent fasting)?
10. How many servings of fruits and vegetables do you typically consume per day?
11. Do you have any food allergies or intolerances?
Fitness & Activity
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12. What is your current level of physical activity?
13. What types of exercise do you currently engage in?
14. How many days per week do you engage in physical activity?
15. What is your primary fitness goal?
16. What is your biggest challenge when it comes to fitness?
Wellness & Mental Health
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17. How do you typically manage stress?
18. How often to you practice self-care or relaxation techniques (e.g., taking time for yourself, relaxing activities)?
19. Do you feel like you have a work-life-routine?
Goals & Motivation
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20. What motivates you to improve your fitness and wellness?
21. What are your short-term fitness goals (next 3-6 months)?
22. What are your long-term fitness goals (1 year +)?
23. How committed are you to achieving your fitness goals on a scale from 1-10? 1 being not committed and 10 being highly committed.
