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Client Survey
SEVEN QUESTIONS THAT WILL ALLOW US TO HELP YOU REACH YOUR FULL POTENTIAL.
1. What are you interested in learning more about? (Check all that apply)
*
Group Classes
Personal Training
IMPACT Training (small group)
Nutrition Coaching
Other
Please Explain:
*
2. What is/are your main fitness goals that we can help you with? (Check all that apply)
*
Weight loss
Muscle tone & definition
Increase strength
Increase energy
Increase flexibility
Other
Please Explain:
*
3. What aspects of your health can we help you with? (Check all that apply)
*
Increase cardiovascular endurance
Reduce stress
Reduce back/joint pain
Reduce cholesterol
Reduce blood pressure
Improve eating habits
Improve daily lifestyle habits
Other
Please Explain:
*
4. Are you currently exercising?
*
YES
NO
5. Do you eat a healthy, well-balanced diet?
*
YES
NO
SOMETIMES
6. How many days per week do you plan on incorporating fitness into your life?
*
2
3
4+
7. What times are most convenient for you?
*
EARLY MORNING
MID-MORNING
AFTERNOON
EVENING
YOUR CONTACT INFO:
Name
*
Email Address
*
Phone Number
*
How would you like to be contacted?
*
Email
Phone
ADDITIONAL RESPONSES REQUESTED (But totally optional)
Have you participated in a health program before?
Yes
No
What worked?
What didn't work?
8. What are you looking for in a trainer?
9. What sort of results do you want to gain from your experience at Impulse?
10. Is there anything else you would like us to know about your health journey?
11. Comments, questions or concerns?
How did you hear about us?
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