Fitness Revolution Brookfield Consultation Questionnaire
Part 1. Basic information
Full Name
First Name
Last Name
E-mail
How did you hear about us and what attracted you to possibly getting started with us?
What are your specific goals?
What have you tried in the past? What did you like and dislike about it?
Whats the activity level at your job?
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
How often do you travel?
Rarely
A few times a year
A few times a month
Weekly
Other
Why do you want to potentially start now?
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
Please rate your readiness for a transformation and readiness to change behaviors for results?
1
2
3
4
5
6
7
8
9
10
Timeline for achieving your transformation.
12 WKS
24 WKS
1 YEAR
2 YEARS
As long As it takes
NOW
What makes a good coach?
What has held you back in the past to seeing the results you want and what happens if you do not change?
What is your greatest fear(s) with your transformation? Check all that apply
Not seeing results
Being embarresed in a group
Not being fit
Not being able to comply with lifestyle changes needed
Lack of commitment
Not wanting to put in the work
Submit
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