QUESTIONEER | ELITE

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BACKGROUND

QUESTIONEER

Please fill out the questioneer to better help us tailor your workouts.

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 cardio level

Your current mobility

How much do you enjoy exercising?

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

Improved body composition

Improved cardiovascular levels

Stress relief

Improved muscle strength

Improved muscle endurance

Bigger muscles

Improved mobility

More energy

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 do you sleep / night (avg)?

How many hours of sleep do feel you need?

Sleep quality

Things that affect your amount of sleep and sleep quality

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

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

Thanks for submitting!

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