Physical Activity Readiness Questionnaire Step 1 of 9 - ___Basic Info___ 11% HiddenCoach Query String Name(Required) First Last Email(Required) PLEASE USE THE EXACT EMAIL YOU USED WHEN PURCHASING YOUR TRAINING PROGRAMEmergency Contact Name(Required) First Last Emergency Contact Phone(Required)Age(Required)Gender(Required)MaleFemaleHeight (In Inches)(Required)Current Weight (lbs)(Required)Primary Goal(Required)Lose WeightBody Recomposition - Maintain WeightBuild MuscleWhat is Your Short-Term Fitness Goal? (30-90 Days)(Required) What is Your Mid-Term Fitness Goal? (90-180 Days)(Required) What is Your Long-Term Fitness Goal? (180 + Days)(Required) Rate The Level Of Accountability You Prefer(Required) 1 - Very little Accountability Needed. (Just occasional check-ins and words of encouragement.) 2 - Moderate Level of Accountability is Needed (Don't let me get away with skipping workouts or check-in calls.) 3 - High Level of Accountability Needed (Frequent messages, don't allow skipped workouts and do not accept excuses!) Please Select A Coach(Required) Milly Please Select A Coach(Required) Milly Tate Please Select A Coach(Required) Milly Tate Cameron Please Select A Coach(Required) Milly Cameron Please Select A Coach(Required) Tate Please Select A Coach(Required) Tate Cameron Please Select A Coach(Required) Cameron Please Select A Coach(Required) Sammy Please Select A Coach(Required) Cameron Sammy Please Select A Coach(Required) Tate Cameron Sammy Please Select A Coach(Required) Milly Tate Cameron Sammy Please Select A Coach(Required) Tate Sammy Please Select A Coach(Required) Milly Tate Sammy Please Select A Coach(Required) Milly Cameron Sammy Please Select A Coach(Required) Milly Sammy Physical ReadinessPlease Check All That Apply. If None, Click "Next" On The Bottom Left. Has your doctor ever said that you have a heart condition and that you should limit activity? Do you feel pain in your chest when you do physical activity? In the past month, have you had chest pain when you were not doing physical activity? Do you lose your balance because of dizziness or do you ever lose consciousness? Do you have a bone or joint problem that could be made worse by a change in your physical activity? Is your doctor currently prescribing drugs for your blood pressure or heart condition? Medical Condition. Please Check All That Apply. If None, Click "Next" On The Bottom Left. Heart Condition Asthma-uncontrolled Shortness of Breath Arthritis Bursitis Osteoarthritis Rheumatism Hernia Recent Surgery Sacroiliac Problems Angina High Blood Pressure Knee Problems Back Problems What Are Your Current Medications? Do You Have Any Injuries That Affect Exercise? Describe your occupation and typical workday(Required)How Many Hours Each Day Do You Sit?(Required) Less Than 1 Hour 2 - 4 Hours 4 - 6 Hours More Than 6 Hours What Kind of Shoes Do You Wear Most Often?(Required) Flat Shoes Athletic Shoes Mid-Heel Dress Shoes High Heels / Heeled Boots How Would You Rate The Stress Level Of Your Job?(Required) 1 - Not Stressful 2 - Moderatly Stressful 3 - Short Periods of High Stress 4 - Long Periods of High Stress 5 - Stress In a Constant Potential Life Threatening Environment What, If Any, Are Your Hobbies? Personal Fitness Goals(Required) Appearance (Aesthetics) Cardiovascular endurance Flexibility Health (General) Muscular definition Muscular size (Hypertrophy) Muscular strength/power Speed & Agility Self-esteem or confidence Sports specific training Stress reduction Fat loss (Weight loss) Corrective exercise (Post-rehabilitation) Other fitness goals or desires not indicated above Athletics, Sports & RecreationIn this section, please share the sport or recreational activities in which you participate. If you are an advanced athlete and require or desire sports specific training or corrective exercise please explain your needs in the “Additional Details” section at the bottom of this page. If you are not necessarily an advanced athlete but would like to participate in one of the Sport's below please indicate your desire in the “Additional Detail” section at the bottom of the page. American Football Baseball Basketball Ice Hockey Soccer Tennis Golf MMA or Wrestling Marathon Athlete Triathlon Athlete Hiking - Back Country Oar or Paddle Boating Tough Mudder, Spartan or Other Hybrid Event 3,k, 5k or 10k Runs (Leisure or Competitive) Any Other Sport or Activity Not Listed: Additional Details - Please Specify Needs Related to Your Sport Please describe your current activity or workouts(Required)Rate your experience with exercise(Required) Beginner Intermediate Advanced Competitor Rate your overall activity level(Required) Sedentary Moderately active Active Very Active Competitor Rate your ability to perform cardio exercises(Required) Very low Fair Average Good Competitor What form of cardio do you like best?(Required) Running - Outside Walking - Outside Running - Treadmill Walking - Treadmill Elliptical Trainer Stationary Bike Recumbent Bike Stair Climber Other How Would Your Rate The Quality of Your Nutrition?(Required) Very Poor (Fast Food, Microwave Meals, Soda, or Sweets) Poor (Some Fast Food, Occasional Microwave Meals, Soda, and sweets) Average (Rarely eat Fast Food or Microwave Meals, Occasional Soda and Sweets) Mildly Healthy (Almost No Fast Food or Microwave Meals. Rare Soda or Sweets) Healthy (No Fast Food or Microwave Meals. No Sods and Rare Sweets) How Many Alcoholic Beverages Do You Consume Weekly?(Required) None 1-3 3-6 6 or more What equipment do you have access to?(Required) Free weights (dumbbell/barbells) Gym machines (Freemotion, Precor, Cybex, etc.) Cable machines Resistance bands Bosu ball Stability ball Kettlebells Suspension training (TRX) Bowflex or other home gym No equipment Please Check All That ApplyPlease Describe Your Training Enviroment(Required) Dietary Preferences(Required)BalancedGluten-freeLactose-freePlant-basedWhat Days Do You Plan To Work Out(Required) Monday Tuesday Wednesday Thursday Friday Saturday Sunday How Frequently Do You Expect To Exercise(Required) 1 - 3 days each week 4 - 5 days each week 6 - 7 days each week I plan to follow my trainers recommendation Is there anything else you would like your trainer to know?