Simply answer the following questionnaire as truthfully as possible and you'll receive the answers you need to reach your personal health and fitness goals! It's free, quick, and easy to use. We're confident you'll find this fitness analysis very helpful. Enjoy!
 
 

I. Personal Info/Profile

Name:
E-mail Address (e.g., jones@aol.com):

Please subscribe me to The Fit Zone's free weekly newsletter of fit tips, answers to frequently asked fitness questions, healthy recipes, motivational articles, and the latest discoveries in the fitness industry!

Gender:Male Female

Age: 

Height: Feet Inches

Weight:(please indicate if in Lbs. or Kgs.)

Body fat % (if known): 
 
 

II. Physical Condition and Lifestyle

Are you pregnant or planning to be in the near future?YesNo

Do you currently have any physical pain (e.g., low back pain) that may prevent you from doing certain exercises or activities? If so, please list:

Have you had any injuries or surgery that we should take into account in developing a safe, effective program for you? If so, please list:

Do you have any special conditions (e.g., high blood pressure), limitations (e.g., arthritis), or disease (e.g., diabetes) that should be taken into account? If so, please list:

Do you drink alcoholic beverages? If so, how often?

Per Week 1  2  3  4  5  6 7

Per Day 1  2  3  4  5  6 or more drinks

How would you best describe your activity level?

Sedentary	Moderately active
Fairly inactive	Very active

Do you smoke? Yes No

Do you use the scale to measure your progress or are you concerned with your weight, regardless of how you look and feel?YesNo
 
 

III. Goals and Interests

Please rate the importance of what you'd like to achieve:

Improve muscle strength	Not Important Important  Very Important
Increase bone, tendon, and ligament strength (injury prevention and improved athletic performance)	Not Important Important  Very Important
Improve muscle endurance	Not Important Important  Very Important
Improve muscle tone/definition	Not Important Important  Very Important
Increase muscle size (entire body or specific muscle group)	Not Important Important  Very Important
Decrease or maintain current level of body fat	Not Important Important  Very Important
Improve metabolism (condition body to "burn" fat more efficiently)	Not Important Important  Very Important
Improve appearance	Not Important Important  Very Important
Improve cardiovascular performance (endurance, intensity, etc.)	Not Important Important  Very Important
Improve flexibility	Not Important Important  Very Important
Decrease cholesterol and/or blood pressure	Not Important Important  Very Important
Increase energy	Not Important Important  Very Important
Improve self-esteem and confidence	Not Important Important  Very Important
Decrease stress, anxiety, and depression	Not Important Important  Very Important
Decrease risk of illness and disease	Not Important Important  Very Important
Decrease or prevent pain, rehabilitate an injury, and/or recover from surgery	Not Important Important  Very Important

 

IV. What Would Help You Achieve the Goals Listed Above?

Learn ways to stay motivated and focused on my goalsYesNo

Get help in setting realistic, yet challenging short-, medium-, and long-term goalsYesNo

Learn training techniques to:
make my program fun and exciting
prevent boredom
overcome plateaus

Help me continually achieve new levels of results, again and again YesNo

Receive success stories and tips from people who have achieved great results with their fitness program YesNo

Receive regular updates on recent discoveries and trends in the fitness industryYesNo

Get great tips for fitting exercise into my schedule and making my program as effective as possible in the time I have availableYesNo
 
 

V. Personality Profile

To help us learn more about you, please rate yourself on the following on a typical day:

Energy Level	Low	Moderate	High
Anxiety and/or Stress	Low	Moderate	High
Depression	Low	Moderate	High
Headaches	Rare	Sometimes	Frequently
Fatigue	Low	Moderate	High
Sleep pattern	Poor	Okay	Good
Self-esteem/Confidence	Low	Moderate	High
Bingeing	Rare	Sometimes	Frequently
Emotional eating	Rare	Sometimes	Frequently
"Cue-sensitive" eating (e.g., you eat when watching TV because it's a habit)	Rare	Sometimes	Frequently

 

VI. Nutrition Questionnaire

Do you eat fewer than five servings of fruits and vegetables per day? YesNo

Do you need help decreasing the amount of fat and sugar in your diet?YesNo

Do you need help increasing fiber, vitamins, and minerals in your diet?YesNo

How many days a week do you eat out? 1 2 3 4 5 6-7

Would you like easy-to-follow tips for making the foods you love healthier:

a. when eating out or at social gatherings? Yes No
b. when shopping and cooking at home? YesNo

Are you allergic to any foods or do any cause you discomfort (cramps, nausea, etc.)?YesNo

How many days a week do you skip breakfast?Never 12 3 4 5 6 7

How many meals and snacks do you eat a day?Full-size meals Snacks

Do you go too long without eating, causing you to feel "starved" at mealtime?YesNo

What is your usual eating pattern in the evening or late night?
Often skip
Medium-size meal
Lightest meal of my day
Biggest meal of my day

How much water do you drink a day (8-oz. glasses)?1-3 4-67-8 9 or more

Please list a few of your very favorite foods

 
 

VII. Exercise Questionnaire

How often and how long are your current average workouts?
Days per weekMinutes per session

How often and how long would you like your workouts to be? Please make sure this is realistic for your schedule and fitness level.
Days per weekMinutes per session

Please describe the equipment/facilities you have available:
Health ClubHome Gym/equipment
Currently no home equipment or access to a club

A. Strength Training (Weightlifting)

Please describe your strength training fitness level/experience:
Beginner (less than 1 year total experience OR 1+ year but none recently)
Intermediate(1-3 years total OR 3+ years but none recently)
Advanced(3+ years with a trainer)

Are you currently on a strength training (weightlifting) program?Yes No

1. If yes, please answer the following to best describe your routine:

I do a "Circuit Training" program
I do a "Split Training" program (1-4 muscle groups one session, other groups next session)
Other (please explain)
2. How many sets and repetitions do you usually do for each exercise? Sets Reps
3. Do you allow at least 1-3 days of rest between training specific muscle groups? Yes No
4. Do you switch the order of the muscle groups and exercises in your routine? YesNo
5. Do you continually try new exercises and training techniques? Yes No
6. Do you continually achieve new levels of results in strength, muscle tone, etc? YesNo

Is cardiovascular exercise (e.g., walking, biking) in your exercise routine?Yes No

If yes, please answer the following 3 questions to best describe your routine:

1. How often and how long do you do cardiovascular exercise?

Days per week Minutes per session
2. Do you monitor your heart rate and try to stay in a heart rate " zone" specific to what you're trying to achieve?Yes No
3. Do you use training techniques (e.g., "interval training") to help prevent boredom and overcome plateaus? Yes No

Do you include stretching exercises in your workout?YesNo

If yes, please answer the following 3 questions to best describe your routine:

1. Do you include stretching exercises for all the major muscle groups? Yes No
2. Do you make sure your muscles are properly warmed up before stretching? Yes No
3. Do you hold each stretch in the furthest comfortable position for at least 10 seconds? Yes No