Exercise History

Name *

First

Last

Email *

Which activities have you done in the past or are currently participating in?

Select all that apply

How often are you currently exercising?

When you exercise, what is the intensity?

Select all that apply

Have you ever had any of the following?

Tick all that apply

Details of health concerns

Please provide details on any injuries indicated above, or any other health related concerns you might have.

What do you plan to do each week to achieve your goals?

Please tick all that apply

If you have a weight loss goal, are you comfortable being weighed?