Aaron Shumake Fitness Challenge
Questionnaire
Full Name
*
First Name
Last Name
Gender
Male
Female
Date of Birth
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Month
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Day
Please select a year
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Year
E-mail
What's App
Please include country code
Instagram
Include @
Age
years
Height
INCHES
Weight
LBS
Part 2. Lifestyle Information
What type of job or work do you do for a living?
Whats the activity level at your job?
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
How many times a week do you work out and for how long? Please explain and be specific
Please list the physical activities that you participate in outside of the gym and outside of work.:
Part 3. Medical and health information
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Part 4. Goals
Current Honest Level Of Fitness You Think You Are At
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10
Honest Level You Want To Be At. Don't just say 10 if you can be truly happy with a lifestyle balanced around 6
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List past attempts, successes, and/or failures in your fitness journey that you know have made an impact ?
What is your goal with this challenge and why?
Please rate your motivational level to do what it takes for reach your goal.
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What are your expectations on me as your Coach?
What are your expectations on me as your Coach?
What are your expectations on me as your Coach?
Pictures will be covered via Whats App
Submit
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