How to get started?

Want to see some positive change in your life &  get started now?

Just fill out our Fast track to Fitness and Nutrition Tracker forms , so we can better understand your Goals and Needs to  create the Fitness program that  is right for you.

Fast Track to Fitness, Exercise Readiness Form.

Name________________________________ Age ____Birth date ______ Height ____ Weight ______

Home address__________________________________ Email ____________________________________ Phone H__________________________ Wk_______________________Cell__________________________

Marital status ___________Do you have children? _____How many? ____What are there ages?____________

Does your family participate in outdoor or physical activity? ______ What type__________________________

What is your occupation? ___________________________________How many hours do you work?_____

Does your job require you to travel often? _____________________How often?__________________________

Do you frequently experience neck, back or shoulder pain during the day? ________

Do you find yourself fatigued during the day? ____________Does eating alleviate it?____________________

 

Has anyone in your immediate family (mother, father, brother, sister) been diagnosed with any of the following?

(Y for yes – N for no)

Heart Disease ___ Stroke ___ High blood pressure___ High cholesterol ___Hypothyroidism ___ Asthma___

Diabetes, Type I ___ Type II __   Gestational ___ at what age? ______ Alzheimer’s ___Parkinson’s’___

Fibromyalgia ____Cancer ____ what type? ________________________________________at what age _____

 

Are you currently under physicians care or taking any medications for any thing? ____

If so, please list all ailments as well as medications and limitations __________________________________

__________________________________________________________________________________________

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Are you pregnant, if so what trimester? ___________ Complications? _________________________________

Have you had any surgeries in the last 10 years, if so what type? ______________________________________

Have you ever broken any bones? ___________ Which ones? _______________________________________ Have you ever been diagnosed with an eating disorder, what kind? ____________________________________ What treatment did you receive ________________________________________________________________

Have you tried many diets? _________ What kind? ________________________________________________ What were the results? ______________________________________________________________________

Are you currently a smoker or have you ever smoked? _________How long ago? _____________________

How many and how often?  less than a pack a day   Pack a day   2 packs a day    3packs a day or more

How frequently do you consume alcohol?    Daily  Weekly  Monthly Social events only  Never

On average how many hours of uninterrupted sleep do you get at night? _________________________________

Has your Physician told you not to participate in physical activity recently, why?____________________________

 

Do you participate in regular physical activity_____ what type____________________How often______________

Have you ever employed a fitness professional to help you with your goals? _________

What was the result?_____________________________________________________________________________

What are your main fitness goals? _________________________________________________________________

Close your eyes and imagine having achieved those goals what would you look like what would your life be like?

What has stopped you from reaching these goals in the past? ____________________________________________

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How important are these goals and how committed to accomplishing them are you? ______________________

What do you feel given your life style is a reasonable time frame to accomplish them? ____________________

Given your life style what is a reasonable frequency for you to exercise? _______________________________

What time of the day do you find your self most successful when exercising? __________________

When would you like to get started reaching these goals? __________________________________

When is a good time to reach you? _________________________________

 

Congratulations on your first step on the path towards improving your fitness and your life!