Fitness Assessment

Thank you for your recent purchase and welcome to your Fitness Assessment(Old). Please answer the following questions to the best of your knowledge in order to design a program that best fits your goals.

Email
Full Name:
Body Fat(Please answer N/A if unsure):
Height:
Weight:
In the past, what has stopped you from getting in shape?
Were you referred to FitnessKensho.com? If so please enter their full name.
How many days out the week are you willing to devote to a training program? Availability? (Ex. 5 days out of the week. Mon, Tues, Thurs, Sat & Sun.)
Do you prefer the program to be designed to be done at the gym or at home? Please choose one.
What can I do to make your training program more enjoyable?
On a scale of 1-5, how would you rate your present fitness level(1=Very Poor 5=Excellent)?
Do you currently have a gym membership? If so which club?
Describe what you would like to accomplish through your training program with me? For example are you trying to lose weight, build muscle or both? Please be as specific as possible in order to create a training program tailored to you.
Are there any exercises that are not recommend by your physician or physical therapist?
How would you describe your level of daily activities? Light(office work) Moderate(manual labor) Heavy(construction)
What hobbies do you enjoy?
Number of hours of sleep per night?
Any special considerations or requests regarding your training program?
On a scale of 1-5, how would you rate your eating habits?(1=very poor5=excellent)?
How many times a day do you usually eat(including snacks)?
Do you know how many calories you eat per day? If yes, how many?
How many times per week do you eat out?
How much water do you drink daily?
Describe in detail what your daily diet consist of? List every meal that you have eaten either today or the previous day. For example, Breakfast: 2 eggs & 2 egg whites scrambled w/ 2 slices of wheat toast, Snack: 1 cup of plain Greek Yogurt w/ 1/4 a cup of Granola & a chopped Banana, Lunch: 5 oz of Grilled Chicken Breast, 1 cup of Brown Rice and Broccoli, etc.

Be sure to click Submit to email your assessment!



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