BACKGROUND QUESTIONEER
Background Questioneer
Estimate your amount of physical exercise the last 12 months
Not at all
1-3 times a week
More than 3 times a week
Please describe your exercise, if regular
What are your reasons for not exercising?
What is the duration of your exercises (avg)
30 minutes
60 minutes
90 minutes
Your current fitness level
Your current fitness level
Your current cardio level
Your current cardio level
Your current mobility
Your current mobility
How much do you enjoy exercising?
How much do you enjoy exercising?
How important is competing to you?
How important is competing to you?
Do you have any negative experiences from exercising?
Choose the sports you are interested in
Walking
Running
Cycling
Swimming
Skiing
Gym
Gym classes
Tennis
Badminton
Squash
Spinning
Alpine skiing
Yoga
Pilates
Mobility
Boxing
Circuit training
Home workout
Volleyball
Other
Other sports:
Working hours / day (avg)
8 hours
8-12 hours
More than 12 hours
Does your work include a lot of physical work?
Yes
No
If yes, please describe
What causes you stress?
How do you deal with stress?
Spare time activites
Have you been diagnosed with any of the following
High blood pressure
High cholesterol
Heart disease
Diabetes
Joint disease
Back disease
Any chronical disease
Pregnancy (past 6 months)
If yes, please describe
Does any heart of cardiovascular disease run in your family?
Have you suffered any injuries (past 6 months)?
Yes
No
If yes, please describe
Has your doctor at any point prevented you from regular exercise?
Yes
No
If yes, why?
Do you use drugs / medicine on a regular basis?
Yes
No
If yes, what and why?
Please describe your goals with your own words
Weight loss
Weight loss
Improved body composition
Improved body composition
Improved cardiovascular levels
Improved cardiovascular levels
Stress relief
Stress relief
Improved muscle strength
Improved muscle strength
Improved muscle endurance
Improved muscle endurance
Bigger muscles
Bigger muscles
Improved mobility
Improved mobility
More energy
More energy
Improved wellbeing
Improved wellbeing
Other
How much do you want to change your weight?
How much are you ready to work to achieve your goals?
How much are you ready to work to achieve your goals?
How much do you sleep / night (avg)?
How many hours of sleep do feel you need?
Sleep quality
Sleep quality
Things that affect your amount of sleep and sleep quality
Engergy level
Engergy level
How many meals do you eat / day?
Breakfast
Snack 1
Lunch
Snack 2
Dinner
Snack 3
Snack 4
Snack 5
Quality of nutrition
Quality of nutrition
I have volunteered to participate in a program of physical exercise under the direction of Elite Trainers / Healthy Boss, which will include, but may not be limited to, weight and/or resistance training. In consideration of Elite Trainers / Healthy Boss agreement to instruct, assist and train me, I do here and forever release and discharge and hereby hold harmless Elite Trainers / Healthy Boss and their employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting therefrom.
THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT THAT MAY MALFUNCTION OR BREAK; AND (2) ANY SLIP, FALL DROPPING OF EQUIPMENT (3) ANY INJURY THAT MAY OCCUR AS A RESULT OF EXERCISING OUTDOORS INCLUDING CAR ACCIDENT AND INJURIES RELATED TO GLASS OR OTHER DEBRIS ON EXERCISE SURFACES.
I accept the terms and conditions
Submit
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