Fitness Needs Assessment Form
Fitness Needs Assessment Form
Please complete this form to allow us to assess your fitness needs.
Personal Information
Name
Address
Phone number
Assessment
Rate the following using the designated scale for each item.
How would you rate your overall diet?
How would you rate the quality of your sleep?
How would you rate your current stress level in your daily life?
How would you rate your energy levels throughout the day?
How would you rate your fitness experience?
Fitness Goals
What is your primary fitness goal?
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Weight Loss
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Strength Increase
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Mental Health Improvement
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Tone Up
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Lifestyle Change
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How important is your goal to you?
Reason
Please describe your main reason(s) for setting this goal:
What has stopped you from taking action so far?
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Lack Of Motivation
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Lack Of Time
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Procrastination
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Do you have a specific timeline for achieving your goal?
If yes, please describe your timeline:
