Name: |
Phone Number: |
Email: |
MaleFemale |
STEP 1: Goal |
What is the single most important goal for you to achieve with your exercise program? |
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What outcomes are you looking to experience as a result of your exercise program? |
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In what time frame do you expect to achieve your goals? |
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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? |
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Are all aspects of your workouts completely up to you or is someone or something else a consideration when designing your program variables? (your obstacles) |
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Do you have any present or past injuries? Do they still bother you in any way? |
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Do you have any medical history I need to know about? Do you take any medications? |
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How many days a week do you plan on working out? |
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What equipment do you have access to? |
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STEP 2: Style |
Is it more important for you to feel continually challenged or to feel structured during your workouts? |
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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? |
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Do you enjoy exercise more when it involves a routine that you can adhere to or one that offers a variety? |
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Are there any activities you don't like or want to avoid? |
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Are there any activities that you enjoy or want to try? |
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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 |
STEP 3: Level |
Would you say that your work is active, sedentary or physically strenuous? |
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What is your occupation? |
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What hobbies do you enjoy? |
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Do you regularly participate in recreational activities? Is that monthly, weekly, more or less frequent? |
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Are you currently exercising? If yes, what type of exercise program are you currently participating in? |
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What has prevented you from achieving your goals in the past? |
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What is your experience with working out? |
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STEP 4: Motivation About Goal |
Why is this goal most important to you? |
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If you don't make these changes and stay the way you are or regress in your health and fitness, how would that affect your life? What consequences could occur? |
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When you do successfully reach your goal, in what ways will life be different? |
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What benefits are most important to you? |
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On a scale from 1-10 how important is it for you to make those changes right now? |
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Why is it not a 2 or 3? |
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What would make it a number higher? |
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Do you believe you can make these changes? |
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On a scale from 1-10 how confident are you? |
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What would make your confidence one number higher? |
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Are you ready and willing to change at this time? |
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In what ways do you believe I can help you? |
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