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Fitness Assessment Questionnaire
Please answer all questions accurately to allow us
to fully determine your individual needs
Full Name
Date
Email
Contact Number
Gender
Age
Height
Weight
Body Fat Percentage %
Visceral Fat Rating
Muscle Mass (KG)
BMR
Have you been a member of a gym before?
Have you been exercising regularly for the past 6 months?
Have you embarked on any fitness programme before?
Do you smoke?
How many times per month do you consume alcohol?
I would like to:
Lose weight
Gain weight
Feel better
Look better
Live healthier
How often do you eat out?
Please list the habits you would like to change (with regards to health and fitness):
What motivates you in achieving your goals?
On a scale of 1-10, how motivated are you about achieving your goals?
1
2
3
4
5
6
7
8
9
10
What external factors have impeded your progress in the past?
Time
Lack of knowledge
No Facility
Procrastination
Lack of support
Is there anything else your instructor should be aware of?
Coach’s Name
Training Locations
SUBMIT!
Thank You for Submitting!
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