Name
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First Name
Last Name
Email
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Phone
Country
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Date of Birth
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MM
DD
YYYY
Gender
What are your goals? (select all that apply)
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Do you have any specific health concerns or areas you'd like to focus on in our sessions?
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One a scale of 1 - 10, how committed are you to changing your current exercise routine? (1 being not ready at all, 10 being ready to start today)
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One a scale of 1 - 10, how committed are you to changing your current diet? (1 being not ready at all, 10 being ready to start today)
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10
Do you have any current medical conditions (e.g., heart disease, diabetes, high blood pressure, asthma)?
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Are you currently taking any medications or supplements?
Do you have any past or current injuries?
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Do you have any food allergies or intolerances?
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Do you have any gastrointestinal issues (e.g., bloating, indigestion, acid reflux)?
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How many hours of sleep do you typically get each night?
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How would you rate your stress levels (1 being not stressed and 10 being extremely stressed)?
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Do you smoke or use tobacco products?
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Do you drink alcohol?
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Do you have a sedentary job or a physically demanding job?
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What is your current fitness routine (if any)? (How many days per week do you exercise? What types of activities do you do. ex. cardio, weightlifting, yoga, running)?
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Have you worked with a personal trainer before?
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What motivates you to workout?
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Are there any specific areas of your body you'd like to focus on (ex. core, legs, arms)?
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What challenges have you faced in achieving your fitness goals in the past?
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Do you have any fitness-related goals or events coming up? (e.g., wedding, vacation, race, sports competition)
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How many days a week do you currently exercise?
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If you are exercising, list why types you're currently doing
Please list what kinds of exercise currently interest you (ex resistance training, cardio, HIIT, etc)
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How would you rate your current fitness level?
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What types of exercises have you found most effective or enjoyable in the past?
How would you describe your current eating habits?
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How often do you eat out per week?
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How many cups of water do you drink each day?
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Do you have any dietary restrictions or preferences?
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Do you feel like your nutrition supports your fitness goals?
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Do you track your calories or macronutrients (e.g., carbs, protein, fats)?
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Do you have any issues with overeating, undereating, or emotional eating?
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Do you have any difficulty with meal planning or preparation?
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Do you follow any specific diet (e.g., vegetarian, keto, gluten-free)?
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What does a typical day of eating look like for you? (Include all meals and snacks)
What is your primary motivation for starting personal training and nutrition coaching??
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What obstacles or challenges do you face when trying to stay active or committed to a fitness routine?
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What challenges or obstacles do you face when trying to eat healthy?
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How do you typically stay motivated to exercise?
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Are you open to changing your routine, diet, or lifestyle to achieve your goals?
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How often would you like to exercise in a week?
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What do you feel is your biggest obstacle when trying to reach your workout goals?
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By engaging in services with Pure Synergy, LLC, you acknowledge that the fitness advice and nutrition guidance provided are intended for educational and informational purposes. While every effort will be made to help you achieve your fitness and nutrition goals, individual results may vary, and no specific outcomes are guaranteed. Pure Synergy, LLC is not liable for any injuries, health conditions, or other issues that may arise during or after following the advice or programs offered. It is recommended that you consult with a healthcare provider before beginning any fitness program, especially if you have any pre-existing health conditions or concerns. Participation in the fitness and nutrition consultation is voluntary, and all decisions regarding exercise and physical activity are made at your own risk.
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