FITNESS & HEALTH SURVEY - THE ROKFORCEFUSION METHOD

THE ROKFORCEFUSION METHOD

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FITNESS & HEALTH SURVEY

Fitness Questionnaire/Screen

Answer all the questions below.
Please give as many details as possible.
You will be contacted promptly. Please specify best way to be contacted (WhatsApp, or direct phone line call/message is preferable).

*Please give detailed responses

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Preferred method of communication *

WhatsApp Text Message Direct Call Email

Emergency Contact Name *

First

Last

Emergency Contact Email *

Emergency Contact Phone Number *

What are your main fitness goals? Please explain. *

What is your current fitness program routine? *

What do you like least about your current training program *

What do you like the most about your current fitness program? *

Do you have any injuries, taking any medication or are under a doctors care? If yes please explain. *

Is body composition interfering with the performance of the simple of daily tasks? (i.e. clinically obese?) *

NO YES

Do you have a history of high blood pressure? *

NO YES

Do you have a family history of coronary disease prior to age 50? *

NO YES

Do you have Diabetes? *

NO YES

Have you ever had: *

A heart attack Cardiac surgery Extreme chest discomfort High blood pressure (over 140/90) Heart murmurs Ankle swelling Any vascular disease Unusual shortness of breath Fainting spells Asthma, emphysema, or bronchitis Not Apply

Do you: *

Smoke Drink excessively (more than 1-2/day) Have poor sleeping habits (less than 8 hrs/night regularly) Not Apply

What is your age? *

What is your approximate height? *

How many hours of sleep are you averaging per night? *

How many hours per week are you training outside of RFF training sessions.Select One *

What area of your body can use the most focus? *

What is your strongest point for training? *

What best describes your daily eating habits? *

How many times a day are you defecate? *

How many cups of water do you consume per day? (a cup equals about a quarter of a litre) *

How would you best describe your food profile *

*Optional Do you know your blood type? *

10. How committed are you your fitness/training goals? Please explain in detail. *

Please give any other information about your lifestyle or background that may help the trainer understand your fitness history. ie. Interest, challenges, or areas of challenge not mentioned *

Submit

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FITNESS & HEALTH SURVEY