Training: Starting Point Assessment - Courthouse Club FitnessCourthouse Club Fitness

Starting Point Assessment

Thank you for scheduling your Starting Point Assessment. If you can take a few minutes and fill out the following questionnaire, it will help us to understand what your training needs are. We look forward to seeing you in our club soon!

NAME*
First Last
PHONE*
EMAIL*
Choose the Courthouse Location you plan to attend for your Starting Point Assessment*
- Battle Creek (South Commercial)
- West Salem
- Keizer
- South River Road
- Lancaster
What do you currently do for exercise?*
How often do you take part in physical exercise?*
Have you been following this routine consistently for the past three months?*
On a scale from 1 to 10, how would you rate your nutrition (10 being the very best)?
Please enter a number from 1 to 10.
Click on the areas of nutrition you would like to improve*
- Finding healthy snacks
- Eating at restaurants
- Meal prep
- Drinking water
- Increasing protein
- Portion Control
- Emotional Eating
On a scale from 1 to 10, how would you rate your stress level?*
Please enter a number from 1 to 10.
List your three biggest sources of stress (time, work, family, budget, etc.)*
Please select all that apply*
- I am currently in physical therapy
- I have an upcoming surgery scheduled
- I have bone/joint problems
- I have other health concerns that cause pain and/or limitation
- I have no current injuries
If anything, what could potentially stop you from reaching your fitness goals?*
How can a personal trainer help you (choose all that apply)?*
- Lose body fat
- Develop muscle tone
- Rehab an injury
- Nutrition education
- Start an exercise program
- Advance my exercise program
- Safety
- Athletic Training
- Increase muscle mass
- Motivation and accountability