Free Fitness Evaluation

Please answer as many questions as you can and I will send you a free evaluation so you can plan your next step towards greater health and fitness!

Name:     Date:

Email:

Age:     Gender: Male Female

Height: ft inches     Weight: lbs.

Waist: inches     Hip: inches

Body Fat Percentage: (if you know it)
    if so, Date it was measured (Month, Year):
    How it was measured (caliper, machine, etc.)
    Where it was measured:

1. Please rate yourself on a scale from 1 to 5 (lowest to highest).

Characterize your present athletic ability:
1 2 3 4 5
When you exercise, how important is competition:
1 2 3 4 5
Characterize your present cardiovascular capacity:
1 2 3 4 5
Characterize your present muscular capacity:
1 2 3 4 5
Characterize your present flexibility capacity:
1 2 3 4 5

2. Do you currently participate in any exercise, sports or recreational activity? Yes No
If so, what type:
How many times per week?

3. What do you want exercise to do for you? Please use the following scale: 1 (not at all important) to 5 (extremely important)

Improve cardiovascular fitness
Body-fat weight loss
Reshape or tone my body
Improve performance in a specific sport
Improve moods and ability to cope with stress
Improve flexibility
Increase strength
Increase energy level
Feel better
Enjoyment
Other:

4. Do you have any health conditions that limit your fitness activities?

5. Any other questions, fitness concerns or personal goals not addressed above:

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