1. Age

This field require a number

2. Sex

• Male
• Female

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3. Generally speaking, would you say that your current level of fitness is:

• Very good
• Good
• Fair
• Poor

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4. Do you have previous weight room training experience?

• yes
• no

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5. How many times a week are you thinking of training?

• 2 days a week
• 3 days a week
• 4 days a week
• 5 or more days a week

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6. How much time can you allow for each training session?

• 30 minutes per session
• 40 minutes per session
• 60 minutes per session
• 90 minutes per session

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7. What is your main goal?

• Acquire a more active lifestyle
• General fitness
• Enhanced appearance
• Weight loss
• Define or bulk up muscle mass
• Improve flexibility
• Alleviate back pain
• Improve posture
• Enhance my cardiovascular system
• Improve sports performance
• Be supervised for my heart problems
• Manage my stress better
• Control my diabetes better
• CQuit smoking
• Change my eating habits

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8. In how much time do you wish to reach your goal?

• 30 days
• 60 days (2 months)
• 90 days (3 months)
• 120 days (4 months)
• 180 days (6 months)

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9. In weight management terms, would you say:

• I would like to maintain my current weight
• I would like to lose about 10 pounds
• I would like to lose between 10 and 20 pounds
• I would like to lose between 20 and 30 pounds
• I would like to lose more than 30 pounds
• I would like to put on weight

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10. How do you consider your eating habits?

• I eat healthily all the time
• I eat healthily most of the time
• I find it hard to eat healthily
• I tend to eat unhealthy foods

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11. Have you ever been unsuccessful when dieting?

• Yes
• No

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