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Getting Started with Better You Fitness
BASIC INFO
First name
*
Last name
*
Email
*
Phone
*
Age
Occupation
YOUR GOALS
What would you like help with? (check all that apply)
*
Lose body fat
Get stronger
Improve Energy
Move better / feel better
Build consistency
Just getting started
What would you like to see change over the next 3–6 months?
Why is this important to you right now?
YOUR CURRENT ROUTINE
How active are you right now?
Not currently exercising
1-2 days per week
3-4 days per week
5+ days per week
Have you followed a structured workout plan before?
Yes
No
If yes, what have you done in the past?
SCHEDULE AND EQUIPMENT
Where will you be working out?
At home
At a gym
Both
Equipment Access
*
Dumbbells
Kettlebells
Bands
Cable Machine
Gym access
No Equipment
Other
How many days per week can you realistically commit?
*
2 days
3 days
4 days
5 days
About how long would you like your workouts to be?
*
20-30 minutes
30-45 minutes
45-60 minutes
INJURIES OR LIMITATIONS
Do you have any injuries, pain, or limitations I should know about?
*
Yes
No
If yes, please explain
Are there any movements you know don’t feel good for you?
LIFESTYLE
How would you describe your energy levels most days?
*
Low
Somewhat low
Moderate
Good
How many hours of sleep do you usually get?
*
Less than 5
5-6
6-7
7+
How would you describe your stress right now?
*
Low
Moderate
High
Is your daily routine mostly:
*
Sitting
A mix of sitting and moving
Active
NUTRITION
How would you describe your eating habits right now?
*
I don’t think about it much
I’m trying, but it’s inconsistent
I’m fairly consistent
Do you track your food right now?
Yes
No
CONSISTENCY & SUPPORT
What has made it hard to stay consistent with a workout routine in the past?
*
What type of support helps you the most? (check all that apply)
*
Structure
Flexibility
Accountability / check-ins
Communication
On a scale of 1–10, how ready do you feel to make a change right now? (1 = not ready, 10 = very ready)
*
Is there anything else you’d like me to know?
Submit
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