Exercise Program Follow-Up Assessment Form
Please complete the Exercise Program Follow-Up Assessment Form to help us evaluate your recent exercise program experience.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
How many weeks ago did you complete the exercise program?
*
How would you rate your overall satisfaction with the exercise program?
*
1
2
3
4
5
How closely did you follow the recommended exercise schedule?
*
All sessions completed
Most sessions completed
Some sessions completed
Rarely completed sessions
Please indicate your progress in the following areas since completing the program.
*
Rows
Improved
No Change
Declined
Physical fitness
1
2
3
Motivation to exercise
4
5
6
Energy levels
7
8
9
What barriers, if any, did you face in maintaining your exercise routine after the program?
Lack of time
Injury or pain
Lack of motivation
No access to facilities/equipment
Other
Which benefits did you experience from the program? (Select all that apply)
Improved strength
Weight management
Better mood
Increased confidence
Other
Do you plan to continue exercising regularly in the next 3 months?
*
Yes
No
Not sure
What support or resources would help you maintain your exercise routine?
Submit Assessment
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