About Youprogram design questionaireName *Name First Name Last Name Email Address * PhonePhone (###) ### #### What outcomes are you looking to experience as a result of your exercise program? What is the single most important goal for you to achieve with your exercise program? In what time frame do you expect to achieve your goals? Aside from your time at the gym, how much additional time per day are you willing to engage in activity that helps you get to your goal – such as daily walks, using the stairs, or home exercise? Are all aspects of your workouts completely up to you or is someone or something else a consideration when designing your program variables? Do you have any present or past injuries? Do they still bother you in any way? Do you have any medical history I need to know about? Do you take any medications? Is it more important for you to feel continually challenged or to feel structured during your workouts? ChallengedStructure When you need to reduce stress do you ideally enjoy activities that are exciting, adventurous and give you a chance to blow off steam, or activities that are practical and relaxing? AdventurousPractical Do you enjoy exercise more when it involves a routine that you can adhere to or one that offers a variety? VarietyRoutine Are there any activities you don’t like or want to avoid? Are there any activities that you enjoy or want to try? Does your occupation require extended periods of sitting? YesNo Does your occupation require repetitive movements? YesNo Does your occupation cause you anxiety or mental stress? YesNo Would you say that your work is active, sedentary or physically strenuous? ActiveSedentaryStrenuous What is your occupation? What hobbies do you enjoy? Inactive (e.g. reading)Active (e.g. gardening) Do you regularly participate in recreational activities?Is that monthly, weekly, more or less frequent Less FrequentMonthly/WeeklyMore Frequent Are you currently exercising? Have in past or never exercisedCurrently exercising If yes, what type of exercise program are you currently participating in? What has prevented you from achieving your goals in the past? Thank you for taking the time to fill out my form! I will get back to you within a day!P.S. Did you know you are soooooo good looking?