HPA Custom Fitness Consultation Questionnaire
CONGRATULATIONS! An email explaining how to access the other components of The HPA Brain & Body Fitness Gift Pack is on the way to you. It should arrive within 5-10 minutes. Custom Fitness Consulation is the essential first step of your gift. So be sure to complete and submit it right now so we can help you keep moving forward towards a stronger, fitter body and mind!

INSTRUCTIONS: Answer each question. Click the submit button at bottom of page. Then on the next page you can schedule a time to review your results with us (in person or by video conference) so we can provide your personalized body transformation prescription for maximum results in minimum time. If you're ready to move forward towards your goal, and become a stronger and more version of you, this is an opportunity to get expert support at no cost. So make sure to take advantage of it!

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First and last name *
Age *
Height *
Weight *
Do you have a medical condition that may affect your exercise program? If YES, please describe. *
Are you currently experiencing pain? If YES, please describe. *
Please list the exercise and physical activities you do on a weekly basis, how much time you spend doing them and how many days per week (ex: walking-20 min, 3 days per week; gardening-1 hour, 4 days per week). *
How many weeks or months has your physical activity lifestyle been as described above? *
Do you currently belong to a fitness facility? *
Does stress interfere with your optimal functioning? *
Do you prefer to train: *
What do you want to get out of beginning a new exercise program? Check all that apply. *
Required
Please list the following goals in order to importance to you, from MOST to LEAST important:  INCREASE ENERGY LEVEL, LOSE WEIGHT, KEEP MIND SHARP, DEAL WITH STRESS, AGE BETTER, BE MORE PHYSICALLY FIT, IMPROVE OVERALL HEALTH *
How certain are you that you can achieve these goals with the right plan and support? *
Which of the following types of exercise do you have some experience with? *
Required
Based on past experiences, which types of exercise listed above have you enjoyed the most? *
Based on past experiences, which types of exercise listed above have you least enjoyed? *
With the understanding that the more frequently you exercise, the faster you can get results...over the next month, how many days per week are you willing and ready to exercise for at least 30 minutes? *
What would have to be different for you 12 months from now in order for you to be delighted with your health and physical abilities? *
What would have to be different for you 3 months from now in order for you to be delighted with your health and physical abilities? *
What do you think are the biggest things standing in your way of becoming the best version of you? What has been your "Achilles heel" when it comes to having the body and health you most want to have? *
On a scale of 1 to 10, how do you rate your present desire, readiness and determination (i.e. commitment) to create the body and health you desire? *
NO Commitment
TOTAL Commitment
If your commitment level is not a 9 or 10...why not?  What is holding you back? *
What, if any, fears or doubts do you have about starting a new exercise program? *
Do you have any health conditions, specific concerns, limitations or pains we should know about when developing a fitness program for you? *
What are one or two physical activities (i.e. gardening, hiking, dancing, etc) that you would LOVE to be able to do better (i.e. with more confidence, stamina, skill, ease, etc) 3 months from now? *
A referral is the ultimate endorsement - the ultimate sign of trust.  We are so grateful that so many trust us, and we always want to make sure to thank them for their referrals.  Please tell us who referred you, if applicable.  Thank you! *
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