FITNESS QUESTIOnNAIRE What is Your Sex? Male Female Other/Prefer Not to Say What is Your Age? * 17-24 25-35 36-50 50-65 66+ Prefer Not to Say How Active Are You? * Not Active At All Somewhat Active Very Active What is Your Fitness Goal? * Build Muscle / Gain Weight Lose Weight / Burn Fat Build Muscle / Burn Fat Cardio Vascular Health Improve Overall Lifestyle How Many Days Do You Want to Go to the Gym? 1 Day Per Week 2-3 Days Per Week 4-5 Days Per Week 6-7 Days Per Week Name * First Name Last Name Phone (###) ### #### Email Thank you!