LIFESTYLE EVALUATION FORM


Welcome!
After submitting this form you will be contacted by one of our certified personal coaches for a free try-out session. Congratulations for taking the first step towards a more active and FUNctional lifestyle!

#youarefunctional
Where did you hear about us?? *
 

Why are you interested in Functional Training? Please check all that apply.. *
 

LIFESTYLE RELATED QUESTIONS
1. Do you smoke?
 
2. Do you drink alcoholic beverages?
 
4.Describe your job:
5. On a scale of 1-10, how would you rate your current stress level? (1 - very low)
7. Is anyone in your family overweight?
8. Were you overweight as a child?
 

FITNESS HISTORY
2. Have you been exercising consistently for the past 3 months?
 
5. On a scale of 1-10, how would you rate your present fitness level (1=Worst 10=Best)?

NUTRITION RELATED QUESTIONS 
1.On a scale of 1-10, how would you rate your Nutrition (1=very poor 10=excellent)?
2. How many times a day do you usually eat (including snacks)?
3. Do you often skip meals?
 
4. Do you eat breakfast?
 
5. Do you eat late at night?
7. How many litres of water do you consume daily?
8. Do you feel drops in your energy levels throughout the day?
 
9. Do you know how many calories you eat per day?
 
10. Have you been dieting in the past?
 
11. Besides when you're hungry, do you also eat because you feel...
 
13. Do you eat past the point of fullness?
 

EXERCISE RELATED QUESTIONS 
1. How often do you take part in physical activity? (Minimum 30' mins)
2. If your participation is lower than you would like it to be, what are the reasons?
 
4. Which activities are you currently engaged in?
 Activity# times/weekaverage durationeasy/moderate/intense
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2.
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GOAL SETTING
In achieving your goals, we must first define them to create a blueprint for success
7. Realistically, how often (times/week) do you think you should exercise to reach your goal(s)?

Thanks for answering!

Yur personal data are sefe with us. 

We appreciate your trust in us and therefore we guarantee that we will treat these information with the maximum care and not share/sell them in ANY case to third parties.
Kind regards from all the Coaches of the Functional Training Netwerk!