Name :
Address :
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City or Town :
Province :
Postal Code
Phone
Email
Are
you a member of Goodlife Fitness in Belleville?
If so, how long?
On
a scale of 1-10, what is your present fitness
level (1=worst ever, 10=best ever)?
How
many times per week do you take part in physical
activities?
What
activities are you presently involved in?
If
your amount of exercise is lower than you
would like, what are the reasons?
Do
you suffer from any of the following?
Do
you smoke?
What
fitness benefits would you most like to
accomplish?
List
in order your Top 3 Fitness Goals. Rate their
importance on a scale of 1-10.
Rate
your current nutritional habits on a scale
of 1-10 (1=very poor, 10=excellent).
If
it is not a 10, what are some of the reasons
why? Is it a quality or quantity problem?
Or both?
If
there was one thing a personal trainer could
do for you to help you achieve your goals,
what would it be?
Once
you have achieved these goals, how would you
feel and why?
Will
you receive any motivation and support from
friends and family?
How
many workouts per week could you currently
commit to?
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email Mike
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