Lifestyle Health and Fitness

Fitcamp Questionnaire

health and fitness questionnaire

The questionnaire allows me to gather more information about you, any illnesses or injuries you may have or have had in the past. It also allows you to tell me what your health and fitness goals are. Be as honest and as in depth as possible.

Please complete and submit this form to me.

 
Name *
Name
Gender *
Have you or your family had any of the following? *
Vaginal birth Ceasarean section
Are you breast feeding? *
Yes/ No and Type of exercise (walking, weights, fitness classes)
Do you smoke? *
Have you ever smoked? *
Have you ever injured any of the following areas of your body? *
Which of the following fitness goals are important to you?
I want to:
Which of the following health and lifestyle goals are important to you? *
I want to feel:
Which other health and lifestyle goals are important to you? *
I want to have:
How important to you is it that you achieve the goals you have chosen? *
What areas are you willing to work on to achieve these goals? *
Would you like to follow an easy nutritional plan? * *
In your experience, which phrase best describes your motivation levels? *
From the following list, who is supportive of you achieving your goals? *
From the following list who is NOT supportive of you achieving your goals? *
I herby confirm that all above information is correct and accurate at the time of activity. I know of no reason why i should not participate in an exercise programme. I have been cleared by my doctor or midwife to participate in physical activity. I agree to advise in wrting if any changes to my health should affect my participation. I take part at my own risk and I waive any leag recourse for damages to myself, my child or property arising from participatuion. *