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Servicing the Twin Cities West 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?
SUBMIT
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