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Fitness Evaluation
Name
(required)
Email
(required)
Phone
Gender
Male
Female
Age Range
18-25
26-35
36-45
46-55
Over 55
Current Body Condition
Underweight
Average
Slightly Overweight
Overweight
Greatly Overweight
Do you have high blood pressure, asthma or other chronic breathing problem, back problems, arthritis or other condition that could interfere with your ability to exercise?
Yes
No
Do you smoke?
Yes
No
Are you currently taking any medication that could interfere with your ability to exercise strenuously?
Yes
No
Approximately how many minutes per week do you currently spend in some type of strenuous exercise?
Less than 1 hour
60-90 minutes
Over 90 minutes
If you had to choose one physical fitness goal to attain in the next 4 months, what would it be?
Lose 10 lbs
Improve Health
Lose Inches
Feel more healthy
Have you ever used a Personal Fitness Trainer?
Yes
No
Anything else you would like me to know?
Submit
