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Year
What are your primary fitness goals? (Select all that apply)
How would you describe your current stress level?

Emotional & Mental Health

Would you like a mental health/ emotional approach?
Yes
No

This is optional. If yes, continue with the next 3 questions. If no, skip the next three questions.

Do you currently use exercise to help with:

Fitness & Health Background

Height:

Weight:


Current Fitness Level
Sedentary (little to no exercise)
Lightly active (1-2 days / week)
Moderately active (3-4 days / week)
Very Active (5+ days / week)
Any current or past injuries, surgeries, or medical conditions that may affect exercise?
No
Yes

If Yes, please explain

Are you currently cleared by a doctor for exercise?
Yes
No

Equipment & Environment

Where will you be doing your workouts?
Equipment Available

If other, please explain

Time & Schedule

How many days per week can you commit to working out?
1
2
3
4
5+
Preferred workout length:
Preferred workout time:

Workout Style & Music

Which workout styles interest you?

Please choose 2 or more

Favorite music genres to listen to ( check all that apply):

Optional One-on-One Support

Would you like one-on-one personal training or coaching sessions in the future? (In-person or virtual)
No, written plan only
Yes, I’d like to learn more about one-on-one in the near future
Would you like your coaching to be trauma informed where we find ways to regulate the nervous system and mental well-being using the the fitness approach?
No, Workout plan only
Yes, I’d like health + emotional wellness coaching included
Maybe, I’d like more information before deciding

Agreement

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