Assesment Questions | GVA Peak Performance

First name

Last name

Email Address

Fitness Goals & Lifestyle:

If other, please let me know:

If other, please let me know

Do you have access to a gym or home workout equipment?

Gym

Home equipment

Neither

On a scale of 1–10, how would you rate your current fitness level?

On a scale of 1–10, how would you rate your current nutrition habits?

Personal Development & Mindset:

If other, please let me know:

What are your top 3 personal development goals for the next 6 months?

Have you ever worked with a life coach or mentor before?

YES

NO

On a scale of 1–10, how would you rate your current mindset and mental well-being?

On a scale of 1–10, how motivated are you to make a change in your life?

Health & Medical History:

Do you have any existing medical conditions or injuries? If so, please let me know

Are you currently taking any medication? If so, please let me know

Do you have clearance from your doctor to exercise?

Have you ever experienced chest pain, dizziness, or fainting during physical activity?

Do you have any allergies or dietary restrictions?

Final Notes

Is there anything else you'd like me to know about you, your goals, or your journey?

Yes

NO

If yes, please let me know:

Thank you for taking the time to fill out this form. Please click submit and I will be in touch soon.