What does a regular day look like for you? Please describe.
Your answer
In general, what are your goals? Check all that apply.
Out of all the above concerns, which ones feel most important/urgent?
Your answer
Why?
Your answer
What do you expect from a workout program?
Your answer
Do you understand energy balance (calories in vs calories out)? If yes, please briefly break down what it means in your own words.
Your answer
How, specifically, would you like your habits, your health, your eating, and/or your body be different?
Your answer
Until now, what has blocked you or held you back from changing these things? (if anything)
Your answer
Do you have experience tracking calories?
Clear selection
Are you regularly active in sports and/or exercise? If so, approximately how many hours per week?
Clear selection
Do you know how to perform the following exercises? Check the box for "yes":
What equipment is available to you? Check the box for "yes":
How many days a week are you able to train?
Your answer
How much time are you able to train each day?
Your answer
Approximately how many hours a week do you do other types of physical activity? (ex. housework, walking to work/school, home repairs, moving around work, gardening, etc.)
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Do you have any injuries, physical conditions, disabilities, pain or illness?
Your answer
List any additional therapies/treatments for any injuries or conditions.
Your answer
Right now, are you taking any medications, either over-the-counter or prescription, or supplements?
Your answer
Are you pregnant or nursing?
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What do you do for a living?
Your answer
Does your job entail shift work?
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In an average week, how many hours do you spend in paid employment?
Your answer
In an average week, how many hours do you spend at school or doing school work?
Your answer
In an average week, how many hours do you spend taking care of others? (children, person with a disability, parents, etc)
Your answer
In an average week, how many hours do you spend doing other unpaid work? (commuting, housework, errands, volunteering)
Your answer
On a scale of 1-10, how do you feel about your schedule, time use, and overall busy-ness?
My life is panicked and insane
My life is perfectly calm and relaxed
Clear selection
Given all the demands of your life, what is your typical stress level on an average day?
No stress
Extremely stressed
Clear selection
On average, how many hours per night do you sleep?