Health and Fitness Profile

How many hours per night do you sleep on average?*
How many times do you wake up during the night on average?*
If you wake up in the middle of the night, how long does it take you to fall back to sleep?
Rate your daily stress level, from 1 (no stress) to 10 (max stress)*

What is the activity level at your job?
Do you experience joint pain?*
Are you currently engaged in a specific exercise program? (Check all that apply)
- My own variety of cardio and/or weights at home
- My own variety of cardio and/or weights at a gym
- A DVD program I purchased from an infomercial/online
- Workout classes or programs at a gym or with a trainer
- Other
- Not currently exercising on a regular basis
How many times per week do you do cardiovascular exercise for 30 minutes or more?*
How many times per week do you lift weights for 30 minutes or more?*

What is your current interest level in working with a personal trainer in a customized-for-you fitness and nutrition program?*
If you are interested in working with a personal trainer, which area(s) would you want help in?
What do you feel you currently need the MOST help with regarding your health and fitness goals?*

What do you think could be the main reason(s) why you aren't in the shape you want to be in? (Be honest)
Thank you for taking the time to share more about where you are today in your health, fitness, and nutrition. Is there anything else you want me to know so I can provide the best response for you?
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