Current Fitness Survey

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Client Name*

Date*

MM slash DD slash YYYY

Email*

What would you consider your present attitude toward exercise?*

I can’t stand the thought of it.

I’ll do it because I know I should, but I don’t enjoy it.

I don’t mind exercise, and I know it is beneficial.

I am motivated to exercise.

Other

How would you like to feel about exercise, if you could change your feelings?*

I can’t stand the thought of it.

I’ll do it because I know I should, but I don’t enjoy it.

I don’t mind exercise, and I know it is beneficial.

I am motivated to exercise.

Other

Describe why and any specifics of how you would like to change your feelings about exercise and how those feelings might bring about positive change in your life*

What would you consider your present attitude toward goal achievement?*

I feel that whatever happens, happens, and I’ll roll with the punches.

I set goals and believe it adds clarity and gives me some control over my outcome.

I write down my goals and believe it is a very valuable exercise in determining my future performance and achievement.

I have written goals and I review them often. I believe I have the power to achieve anything I desire and know that setting goals is a vital part of achievement know that setting goals is a vital part of achievement.

Other

How would you like to feel about goal achievement, if you could change your feelings?*

Describe why and any specifics of how you would like to change your feelings about goal achievement and how those feelings might bring about positive change in your life*

How important to you are the concepts of health and well-being?*

I don’t need to put any effort into bettering my health.

I make certain I devote some time and effort into bettering my physical body.

I am committed to maintaining and working to improve my health and physical well-being.

My health and well-being are the foundation of all that I achieve, and they must remain my top priorities.

Other

How would you like to feel about the concepts of health and well-being, if you could change your feelings?*

Describe why and any specifics of how you would like to change your feelings about the concepts of health and well-being and how those feelings might bring about positive change in your life*

How strong and driving is your desire for improvement?*

I’m really pretty satisfied with the way things are. Striving for improvement might leave me frustrated and disappointed.

I’d like to improve but don’t know that it’s worth all the work involved.

I love feeling as if I’ve bettered myself and am open to any suggestions for improvement.

I’m driven to excel and am committed to striving for consistent and ongoing improvement.

Other

How strong and driven would you like to feel about improvement?*

Describe why and any specifics of how you would like to change your feelings about improvement and how those feelings might bring about positive change in your life*

How do you feel about yourself and your abilities (self-esteem)?*

I am not comfortable with the way I look, feel, or perform in most situations.

I would love to change many things about myself although I am proud of who I am.

I’m very good at the things I must do, take pride in many of my achievements, and am quite able to handle myself in most situations.

I have great strength, ability, and pride.

Other

How would you like to feel about yourself and your abilities, if you could change your feelings?*

Describe why and any specifics of how you would like to change your feelings about yourself and your abilities and how those feelings might bring about positive change in your life*

How do you feel about your present physical condition in terms of the way you look?*

I would like to completely change my body.

There are many things about my reflection in the mirror that I’m not comfortable with.

For the most part I look OK, and I can look really good in the right clothing, but I do feel uncomfortable with a few things about my physical appearance.

I am proud of my body and am comfortable in any manner of dress in appropriate situations.

How would you like to feel about the way you look, if you could change your feelings?*

Describe why and any specifics of how you would like to change your feelings about the way you look and how those feelings might bring about positive change in your life:*

How do you feel about your present physical condition in terms of overall health?*

I wish I felt healthy.

I feel healthy for my age compared to most people I meet.

I maintain a high level of health.

I am extremely healthy.

Other

How would you like to feel about yourself and your abilities, if you could change your feelings?*

Describe why and any specifics of how you would like to change your feelings about yourself and your abilities and how those feelings might bring about positive change in your life*

How do you feel about your physical condition in terms of your performance in any chosen physical fields of endeavor (sports, training, etc.)?*

I feel as if I’m in very poor condition and am uncomfortable when faced with a physical challenge.

I am not comfortable with my performance abilities; however, I am comfortable training to improve.

I feel pretty good about my ability to perform physically although I would like to improve.

I have exceptional physical abilities and enjoy being called upon to display them.

Other

How would you like to feel about your performance, if you could change your feelings?*

Describe why and any specifics of how you would like to change your feelings about your performance and how those feelings might bring about positive change in your life*

How strongly do you believe that you can improve your body?*

I believe most of my physical shortcomings are genetic, and most efforts to change would be a waste of time.

I’ve seen many people change their bodies for the better and am sure with enough effort I can see some improvement.

I strongly believe the proper combination of exercise and nutrition can bring about some improvement.

I know without question that with the proper combination of exercise and nutrition I can bring about dramatic changes in my body.

Other

How would you like to feel about your ability to improve your body, if you could change your feelings?*

Describe why and any specifics of how you would like to change your feelings about your ability to improve your body and how those feelings might bring about positive change in your life*

When you begin a program or set a goal, how likely are you to follow through to its fruition?*

I’ve never been real good at following things through to the end.

With the right motivation and some evidence of results I think I might stick to a program.

I have the patience and ability to commit to a program and will give it a chance in order to assess it value.

Once I set a goal, there’s no stopping me.

Other

How would you like to feel about following through on goals, if you could change your feelings?*

Describe why and any specifics of how you would like to change your feelings about following through on goals and how those feelings might bring about positive change in your life*

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Current Fitness Survey

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