Training Questionnaire

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Email *

Name *

Phone *

Where do you live? *

Date of Birth *

YYYY

What neurological condition do you have? *

How long have you had this condition? *

What is your commitment to yourself? What do you hope to get from your training? *

What guides the decisions you make about exercise? *

How would you best describe your exercise routine? (check all that apply) *

I do not exercise regularly

I exercise at least 3x a week

I exercise on weekends

I participate in recreational activities/sports

Other:

Required

What is your primary obstacle to exercising on a regular basis?

What do you consider regular basis? *

Is there a style of exercise or specific exercise that you like? Please explain... *

How often do you prioritize movement in an average week? *

How many hours of sleep do you average per night? *

How do you decide what time to go to bed and wake up? *

Do you have trouble falling asleep? *

How would you rate the quality of your sleep? *

Do you wake up feeling rested? *

Does your sleep affect your motivation to achieve your goals? *

Yes

Maybe

What are your biggest stressors? *

In general, do you have emotional support from a significant other, friend, or family member? *

Yes

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