LIFESTYLE QUESTIONNAIRE

First name*

Last name*

Email*

Phone (preferably mobile)*

What is your current/ previous fitness experience (Gym, fitness classes, martial arts, team sports, racquet sports, swimming, etc)?*

What's your current level of fitness?*

Sedentary (little to no exercise)

Beginner (occasional exercise, less than once a week)

Intermediate (regular exercise 1-3 times a week)

Advanced (exercise more than 3 times a week)

What does your current job or daily life involve? How does it impact your physical and mental well-being?*

I work early or late hours

I have a stressful job

I often feel bored or unstimulated

I have a desk job

I have an active job

I drive to work

I walk, run, or cycle to work

My day involves a lot of sitting

Other

What is your typical eating and drinking pattern during a working week? (Including any alcohol, snacks, meals and beverages)*

What is your typical eating and drinking pattern on the weekend?*

How many hours of "good" sleep do you get each night?*

What are the three key goals you want to achieve? (These can be physical, mental, or nutritional goals)*

When are you most able to exercise, and how long can you realistically devote to each session?*

Do you have access to a gym, or will you be using an alternative space such as a park or home?*

What is your proudest personal achievement? (This does not have to be fitness-related)

Date

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