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Servicing the Twin Cities Metro Areas & Southwest Suburbs
Services can also be held virtually across the broader United States

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WELLNESS QUESTIONNAIRE

First name

Last Name

Average Water Consumption in a Day

Average Amount of Sleep Per Night

Average # of Days/Week You Workout

Amount of Time for Average Workout

Any Injuries/Medical Conditions I Should Be Aware of?

Are You Taking Any Medications/Supplements (List All)

Average # of Days/Week You Eat Out * Required

Less than 2

3-4

More than 5

Rate Current Support System * Required

Exellent

Good

Okay

Poor

Rate Current Energy Levels: * Required

High

Medium

Low

Average Daily Caffeine (Cups) Intake * Required

Less than 2

3-4

5-6

More Than 7

Average Alcohol Conumption/Week * Required

Less than 2

3-4

5-6

More Than 7

What Cardio Equipment Do You Enjoy Using?

How Long is an Average Workout?

What Motivates You?

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Twin Cities Location:

1907 Wayzata Blvd E

Suite 318

Wayzata, MN 55391

Southwest Metro Location:

143 Outer Drive

Le Sueur, MN 56058

Contact: (763) 438-8421

tanya.johnson@fitmbsllc.com

Personal Training

Group Fitness Classes

Life, Grief & Loss Coaching

Career Coaching

Lifestyle Coaching

In-Person or Virtual Options available

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