Get Started. Let’s get movin’.Provide Shaina with some info about yourself.MADE TO MOVEFITNESS & HEALTH QUESTIONNAIRE Name * If your name is Joe Cool, that's cool. First Name Last Name Age * Email Address * Phone Number * (###) ### #### Current Body Fat % * If you're unsure, just say "uhhh... my what?" What is your current occupation (desk, heavy lifting, etc)? What does your daily schedule look like? * Do you have any current limitations that Shaina should be aware of, including existing or past injuries, etc? If so, provide them here: * Please provide the health history for you and your immediate family. * What does your current daily nutrition look like? How much water are you drinking per day? Any supplements? * How much sleep do you get per night? Are you waking up and going to bed at the same time everyday? * Do you start exercise programs, but find yourself unable to stick to them? * Yes No If you answered yes, please explain why. * What does your current fitness routine look like? How many times per week? How long are the sessions? How long have you been in this routine? If you don't currently exercise, how long has it been since you have participated in a consistent weekly fitness regimen of any sort? * What kinds of exercises interest you? * Check all that apply. Jogging/Running Biking Rowing Strength Training Weightlifting Gymnastics Core Work Other (please specify below) Other: Check your TOP THREE overarching goals. * What do you want Made to Move help you achieve? Improve cardiovascular/respiratory endurance Improve stamina Improve strength Improve flexibility and/or mobility Improve mood and ability to cope with stress Improve power Improve speed Improve coordination and/or balance Improve agility Improve accuracy Improve form/technique (for any movements) Increase energy level and feel better overall Increase enjoyment in movement routine What are your specific health and fitness goals? Short term (1-3 months) and long term (6 months+)? * Example: 1 strict pull up Where will you be exercising on a regular basis? Please list ALL equipment you will have access to so I know how to properly program for you. You can simply say: CrossFit Box. * Please list any of your 1 rep maxes for any and all power lifts, olympic lifts, gymnastics skills, and/or cardio accomplishments that you currently have and wish to share. * How do you learn best? Watching/seeing movements? Verbal descriptions? Feeling yourself do the movements? Some combination of the three? What motivates and inspires you? What is your purpose for exercising and moving? * Anything else you would like me to know about why you are choosing to begin your Made to Move program? Desired Fitness Program * Select the Fitness program that best suits your needs. Select a Fitness Program I'm not quite sure yet. I need Shaina's help. Remote Coaching Commuter Coaching Personal Coaching When would you like to get started? How many sessions would you like to complete per week? If meeting in person, please list a few options for best days/times to meet. Desired Whole Self Service Are you also interested in working on your overall wellness outside of the gym? If so, select which service you'd prefer. Select a Whole Self Service I shall stick to fitness for now :) Food, Feelings, + Sleep Log Mental Strength Builders Whole Self Package Thank you!
