Page 47 - VAFM Section 1
P. 47
FITNESS ANALYSIS
PLEASE ANSWER ALL QUESTIONS HONESTLY AND ACCURATELY TO ALLOW US TO FULLY DETERMINE YOUR INDIVIDUAL NEEDS.
Basic Information
1. What made you decide to join the gym? ___________________________________________________________________________
How long is your membership? _________________
2. When was the last time you were a member of a gym?
If so where? _____________________________________________________________
Why did you stop? ________________________________________________________
3. How many times have you started and quit a diet or exercise program? (Circle one) 1-5 6-10 11 or more?
4. How many days per week are you able to come in? ____________________ What times? ______________________
5. Who is your supporting cast? Spouse? Workout Partner? ____________________________________________________________
6. How many times do you eat fast food per week? _____How many Alcoholic drinks per week? ___ How many packs of cigarettes per week? ___
How many times a week do you eat junk food? ______How many times a week do you go to a sit down restaurant? ____________
Goals
7. What are your goals?
Look: 2-3 body parts want changed Feel:
8. How important are these goals to you now, on a scale of 1-10 (10 being the highest)? _____
9. How long have you been thinking about accomplishing these goals? __________
10. What events do you have coming up that will help you stay motivated to reach these goals? ____________________________
Education
11. What have you done in the past for your workouts? (Circle all that apply)
Cardio Machines Cardio Classes Machines Free Weights Bands Plyometrics Kettle Bells Bosu/Stability Balls
12. Strength Training VS. Cardio alone? (Draw Diagrams)
10lbs muscle = Burns 3500 calories at rest per week. (Will take 10-14 months to build 10 pounds of lean muscle)
13. Why did you stop or what has prevented you from exercising in the past? (Circle all that apply)
TIME PROCRASTINATION LACK OF SUPPORT ACCOUNTABILITY
BOREDOM DISCIPLINE MOTIVATION INJURIES
14. Have you ever worked with a trainer? Yes / No
15. Besides money is there anything else that would stop you from getting set up on a program today? _________________________________
So if we can find a program that fits within your budget, you’re ready to get set up on a program today, right? _________________________
16. Why would you want to work with a trainer? ______________________________________________________________________________
CURRENT GOAL TIME LINE 12 Month Time Line B._____
1) BW =
2) BF% =
3) LEAN wt. = _______
4) FAT wt. = _______ _______ _______
A.____
HABIT INCHES POUNDS MAINTAIN
3 Months 6 Months 9 Months 12 Months
