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Offerings
Resources
1st Mood-Based Workout App
Body Type Quiz
Healthy Lifestyle Quiz
Access Free Report
Masterclasses + Meditations
Podcasts
Blog
About + Contact
Sign In
My Account
Small Group Training Questionnaire
Small Group Training Physical Activity Readiness Questionnaire
Name
*
First Name
Last Name
Email
*
Welcome! First and foremost, please describe your fitness goals!
*
How did you hear about Small Group Remote Training?
*
Referral
TikTok
Instagram
YouTube
Facebook
Pinterest
Google search
Former or current client
How would you rate your current level of fitness?
*
Poor
Fair
Decent
Awesome!
What is your current level of experience with lifting and resistance training? (All levels are welcome)
*
Beginner
Intermediate
Experienced
Advanced/Expert
Where do you live?
*
(City, State, Country)
What is your primary time zone?
*
(ex: PST, CST, EST, etc.)
How often do you travel outside of your time zone?
*
0-2x per year
3-4x per year
Approximately every other month
1x per month or more
What are your preferred times to train? Please check ALL times that work with your schedule.
*
Mon/Wed at 5am PT / 8am ET
Tues/Thurs at 5am PT / 8am ET
Mon/Wed at 5:15am PT / 8:15am ET
Tues/Thurs at 5:15am PT / 8:15am ET
Tues/Thurs at 6am PT / 9am ET
Tues/Thurs at 6:45am PT / 9:45am ET
Mon/Wed at 6:45am PT / 9:45am ET
Tues/Thurs at 7am PT / 10am ET
Mon/Wed at 7am PT / 10am ET
Tues/Thurs at 7:15am PT / 10:15am ET
Mon/Wed at 7:15am PT / 10:15am ET
Tues/Thurs at 7:30am PT / 10:30am ET
Mon/Wed at 7:30am PT / 10:30am ET
Tues/Thurs at 7:45am PT / 10:45am ET
Mon/Wed at 7:45am PT / 10:45am ET
Tues/Thurs at 8am / 11am ET
Mon/Wed at 8am / 11am ET
Monday/Thursday at 8:15am PT / 11:15am ET
Monday/Thursday at 8:30am PT / 11:30am ET
Monday/Thursday at 8:45am PT / 11:45am ET
Monday/Thursday at 9am PT / 12pm ET
Monday/Thursday at 9:15am PT / 12:15pm ET
Mon/Wed at 9:30am PT / 12:30pm ET
Tues/Thurs at 9:30am PT / 12:30pm ET
Mon/Wed at 9:45am PT / 12:45pm ET
Tues/Thurs at 9:45am PT / 12:45pm ET
Mon/Wed at 10am PT / 1pm ET
Tues/Thurs at 10am PT / 1pm ET
We will be using a few dumbbells, ankle weights, bands, a yoga mat and a ball. Do you have access or are you willing to obtain this equipment for our training sessions?
*
Yes, I have all of this equipment already.
Yes, I have some of this equipment and will grab the rest.
No, I don't have any of this equipment but I'm willing to go get these.
No, I am not willing to get this equipment.
Height
*
Weight
*
Age
*
Please list all injuries, surgeries and/or hospitalizations within the last two years
*
Any other injuries, health conditions and/or physical limitations to know about?
*
Please describe in detail.
Are you currently pregnant?
*
No
Yes
Do you have children? If so, what are their ages?
*
How would you rate the activity level of your profession, or what you do during the day?
*
Sedentary
Moderately Active
Active
Very Active
Do you smoke?
*
No
Rarely
Yes
Do you drink alcohol?
*
If so, how many drinks?
No
Yes, 1-2 drinks per month
Yes, 3-4 drinks per month
Yes, 1-2 drinks per week
Yes, 3-4 drinks per week
Yes, 5-6 drinks per week
Yes, more than 6 drinks per week
Do you have high cholesterol?
*
No
Yes
Has your doctor ever said that you have heart trouble?
*
No
Yes
Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?
*
No
Yes
Has your doctor ever told you that your blood pressure was too high?
*
No
Yes
Please list any current medications you may be taking that could be affected by exercise.
*
Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?
*
No
Yes
Do you ever feel weak, fatigued, or sluggish?
*
No
Yes
Have you reached and maintained your goals?
*
No
Yes
Are you happy with the way you look and your health?
*
No
Yes
Is accountability important to you?
*
No
Yes
Have you ever worked with a personal trainer?
*
No
Yes
If yes, did you achieve your goals with high-quality results?
*
Yes
No
N/A
How many times per week would you like to exercise (not just group training sessions but in total)
*
2
3
4
5
6 or more
Is there a specific event you are training for? If so, please provide type of event and date
*
What are you most interested in? Please check all that apply.
*
Fat burning
Growing my booty!
Seeing my defined abs
Snatching my waist
Toned, defined arms, shoulders and back
Toned, defined legs
Mobility, balance and injury prevention
Better posture
Full body strength
Increased stamina and endurance
Improve overall health
Thank you for taking the time to fill this out! Please add any remaining note-worthy details here.
*
Thank you!
