Wellness Questionnaire

WELLNESS QUESTIONNAIRE

This questionnaire is designed to assess your current fitness track as the first step towards starting/optimizing your wellness journey.

1. How would you describe your health?

Excellent

Good

Fair

Poor

2. GOALS | Areas I want to improve:

Aerobic Endurance

Flexibility

Speed

Power

Strength

Balance & Coodination

Eating Habits

Body Weight Gain or Loss

Injury Rehabilitation

Posture

Blood Pressure

3. List 2-3 barriers and strengths to achieve these goals:

4. How many times/week are you physically active?

Never

1-2 times per week

3-5 times per week

6-7 times per week

5. Please list your favorite physical activity:

Please provide add additional comments that you believe will help us better serve you:

Success!

Thanks for submitting!