South Florida Trainers

What is your first name?

What is your last name?

How much do you currently weigh? (in lbs)

What is your height? (Example: Use 5.9 and not 5'9)

What is your email? (Optional)

What is your gender?

Male

Female

Prefer Not to Answer

Age Range?

18 - 25

25 - 40

40 - 65

65+

How many days a week do you engage in physical activity for at least 30 minutes ?

0-1 Days

2-3 Days

3-4 Days

5-6 Days

How many calories on estimate you think you consume a day?

1000-1500 calories

1500-2000 calories

2000-3000 calories

3000 or more

How would you describe your current diet?

Poor (fast food, processed food, high in sugar)

Average (occasional fast food, some home-cooked meals)

Good (balanced diet, home-cooked meals, low in sugar)

Excellent (predominantly whole foods, balanced nutrients)

Do you smoke?

Yes

No

Do you drink alcohol?

Yes, more than 3 times a week

Yes, 1-2 times a week

Rarely

No

How many hours of sleep do you get per night?

Less than 5 hours

5-6 hours

7-8 hours

More than 8 hours

How would you rate your stress level on a scale from 1 to 5, with 5 being the most stressed?

1-2 (low stress)

3 (medium stress)

4-5 (high stress)

Do you have a family history of heart disease, diabetes, or other chronic illnesses?

Yes

No

How many glasses of water do you drink a day?

Less than 4 glasses

4-6 glasses

7-8 glasses

More than 8 glasses

Fitness Assessment