🏋️‍♂️ NextRepFit Fitness Assessment 🏋️‍♀️

Welcome to your personalized fitness transformation! Complete this assessment to receive your custom plan within 3 hours.

Personal Information

Full Name *

Email Address *

Phone Number *

Age *

Gender *

Select Gender
Male
Female
Prefer not to say

Height (cm) *

Current Weight (kg) *

Health Assessment

Do you have any medical conditions? *

None
Diabetes
Heart Disease
High Blood Pressure
Arthritis
Osteoporosis
Other

Current Medications

🚀 Get My FREE Custom Plan Now! 🚀

🏋️‍♂️ NextRepFit Fitness Assessment 🏋️‍♀️

Welcome to your personalized fitness transformation! Complete this assessment to receive your custom plan within 3 hours.

Personal Information

Full Name *

Email Address *

Phone Number *

Age *

Gender *

Select Gender
Male
Female
Prefer not to say

Height (cm) *

Current Weight (kg) *

Health Assessment

Do you have any medical conditions? *

None
Diabetes
Heart Disease
High Blood Pressure
Arthritis
Osteoporosis
Other

Current Medications

Do you have any allergies?

Any previous injuries or surgeries?

Do you have heart problems? *

Yes
No
Unsure

Do you have diabetes? *

Yes
No
Pre-diabetic

Blood pressure issues? *

Select option
Normal
High
Low
Don’t know

Joint problems? *

Knees
Back
Shoulders
Hips
Neck
Ankles
None

Have you been cleared by a doctor for exercise? *

Yes
No
Need to check

Emergency Contact Name and Phone *

Fitness History

Current fitness level *

Select fitness level
Beginner
Some experience
Intermediate
Advanced
Used to be fit

How many days per week do you currently exercise? *

Select days per week
0
1-2
3-4
5-6
7+

What types of exercise do you currently do? *

Walking
Swimming
Gym workouts
Home workouts
Yoga
Sports
Dancing
None currently

How long have you been exercising regularly?

Select duration
Never
Less than 6 months
6-12 months
1-2 years
2+ years

Do you have access to a gym?

Yes
No
Sometimes

What equipment do you have at home?

Dumbbells
Resistance bands
Yoga mat
Treadmill
Stationary bike
None

Goals & Motivation

Primary fitness goal *

Select primary goal
Weight loss
Muscle gain
Improve health
Increase energy
Build strength
Improve mobility
Feel confident

What motivates you to get fit? *

What are your specific goals? *

Have you tried fitness programs before?

Yes
No

What challenges have you faced?

What does success look like to you? *

Timeline for achieving your goals *

Select timeline
3 months
6 months
1 year
2+ years

Lifestyle & Nutrition

How would you describe your current diet? *

Select diet quality
Excellent
Good
Fair
Poor
Very poor

Do you have any dietary restrictions?

Meals Per Day *

Select meals per day
1-2
3
4
5+

Alcohol Consumption

Select frequency
Never
Rarely
1-2 times/week
3-4 times/week
Daily

Daily Water Intake *

Select water intake
1-2 glasses
3-4 glasses
5-6 glasses
7-8 glasses
More than 8

Hours of Sleep *

Select sleep hours
4-5 hours
6-7 hours
8+ hours

Do you take any supplements?

Stress Level (1-10) *

Availability & Commitment

How many days per week can you commit to exercise? *

Select commitment days
1-2
3
4
5
6
7

Preferred workout times *

Early morning
Mid morning
Lunch time
Afternoon
Evening
Night

How long can each workout session be? *

Select session length
15-30 min
30-45 min
45-60 min
60+ min

Are you willing to follow a nutrition plan? *

Yes
No
Maybe

What is your budget for fitness/nutrition coaching?

Select budget range
$50-100
$100-200
$200-300
$300-500
$500+

🚀 Get My FREE Custom Plan Now! 🚀

Your personalized plan will be delivered to your email within 3 hours!
Questions? Email me directly: aaronperkins0632@yahoo.com