🏋️ Fitness Program Questionnaire
Complete this assessment to generate your personalized program identifier
Confidentiality & Privacy Disclaimer
Your information is protected:
- All personal information provided in this questionnaire is strictly confidential
- Your data will not be shared, sold, or disclosed to any third parties
- Information is used solely for generating your personalized fitness program
- No identifying information is stored beyond this session
- You may discontinue at any time without providing reason
Release of Liability & Assumption of Risk
By completing this questionnaire and participating in any exercise program, you acknowledge:
- Voluntary Participation: Exercise participation is entirely voluntary and at your own risk
- Physical Risks: Exercise involves inherent risks including but not limited to: muscle soreness, injury, cardiovascular events, and in rare cases, death
- Medical Clearance: You confirm you have obtained appropriate medical clearance or will consult a physician before beginning any exercise program, particularly if you have pre-existing medical conditions
- Personal Responsibility: You are solely responsible for monitoring your physical condition, adhering to safe exercise practices, and ceasing activity if you experience pain, discomfort, or unusual symptoms
- Release of Liability: You hereby release, waive, discharge, and hold harmless the program creators, trainers, and associated parties from any and all liability, claims, demands, or causes of action arising from participation in this program
- Informed Decision: You have read this waiver, understand its contents, and voluntarily agree to its terms
1 Basic Information
Leave blank if unknown — your trainer will assess at your first session. Trainer-assessed values take precedence over self-reported estimates.
Rate your tendency toward each body type on a 1-10 scale. Most people are a blend of types.
Naturally lean, narrow frame, difficulty gaining weight/muscle, fast metabolism
Naturally muscular, athletic build, gains muscle easily, medium frame
Wider frame, stores fat easily, slower metabolism, naturally strong
2 Training Goals
Rate each goal category on a scale of 1-10 based on its importance to you. 1 = Not important at all, 10 = Extremely important
Muscle building, lean mass development, body composition improvement
Deep abdominal fat reduction, metabolic fat loss, waist circumference
Maximal force production, lift heavier weights, increase 1RM capacity
Cardiovascular fitness, stamina, aerobic capacity, work capacity
Explosive strength, speed, rate of force development, athleticism
Structural muscle capacity — sufficient mass in key segments to support load distribution and joint protection
Range of motion, movement quality, joint health, tissue extensibility
2B Sport-Specific Training (Optional)
How much should this sport influence your training program? (5% = minimal, 35% = primary focus)
3 Training Experience
“Consistent” means 2+ sessions per week for at least 6 months per year
If you’ve taken a break from consistent training, how long has it been?
4 Movement Assessment
Sum of Squat + Hinge + Push-Up scores
Stand with feet shoulder-width apart, arms raised overhead. Perform 3 slow bodyweight squats. Check anything you notice:
5A Musculoskeletal Injuries & Pain
Check each affected area — a severity slider will appear for each selection
5B Medical Conditions
Nerve damage affecting sensation, balance, or motor control
Check all that apply
Check all that apply
Enables joint-specific programming modifications, load selection, and flare-management protocols
Select all that apply
Check each affected joint — a severity slider (1 = Mild · 5 = Severe) will appear for each selection
Hypermobility Spectrum Disorders (HSD) affect joint stability and require specialized programming
Rate each joint area from 0–10 based on how hypermobile you feel it is. 0 = No hypermobility, 10 = Extreme hypermobility
⚠️ Based on your ratings, you will be directed to our specialized 16-Week Compression & Stability program.
5C Medical History
Previous surgeries, medications, or balance concerns
Especially spine, joint replacements, or major orthopedic procedures
Beta blockers, corticosteroids, blood thinners, or other medications that impact exercise
5D Movement Quality Self-Report
Your trainer uses this section as a starting hypothesis for your movement screen — not a diagnosis. Answer based on what you notice during familiar exercises or daily movement.
Do any muscles feel absent or disconnected during exercise — even in movements that should target them? Select all that apply.
Do any muscles dominate during most exercises — working harder than they should, or substituting when other muscles should be leading? Select all that apply.
Movements like a single-arm row, wood chop, or rotational exercise — do these feel significantly weaker or more effortful on one side compared to the other?
6 Recovery Capacity
7 Schedule & Equipment
How much time can you dedicate per training session?
8 Program Type & Add-Ons
Choose the format that matches your goals
Optional module with personalized nutrition protocols
9A 30/30/30 Morning Fat-Loss Protocol (Optional)
The 30/30/30 is a morning metabolic add-on: 30g protein within 30 minutes of waking, followed by a 30-minute Japanese interval walk. It is assigned only when fat loss is a primary goal and the client confirms morning availability.
9B Areas of Perceived Weakness or Desired Focus
Limited to TWO areas maximum. Be specific and explicit — one entry per line (e.g. “Weak adductors” on line 1, “Desire stronger glutes” on line 2). Your program will bias exercise selection toward these areas based on the shared influence percentage below.
10 Movement Preferences (Optional)
Important: Any preferences you list must relate to the training you will be receiving from your trainer. General fitness preferences within the scope of your program are welcome (e.g., “I enjoy kettlebells,” “I prefer cable machines over free weights”). Preferences outside your trainer’s methodology will be noted but may not be programmed.
Any exercises you want to exclude beyond injury limitations?