Do you consider your job to be physically challenging and/or active? Yes, everyday my job is extremely physically demanding. Yes, most everyday my job is active and physically challenging. Eh, It depends on the day whether I am active or challenged physically in my job. No, my job is not physically challenging and/or active. No, I am retired/I do not have a job/I do not work. How many hours a day do you spend on technology (Computer, Phone, TV, etc.)? Zero, or very little, I watch some TV every now and then, but do not spend hardly any time with technology. Not too much time at all, definitely less than an hour or 2 a day. A moderate amount of time, most days probably 2-5 hours. Technology is part of my job, so I spend anywhere from 5-10 hours on my computer/phone a day. I spend more than hours a day on technology. Rate the amount of stress in your career. 1 - Little to no stress. 2 3 - A moderate amount of stress, depending on the day. 4 5 - My job has me stressing out basically all day, everyday. Rate the amount of stress in your personal life. 1 - Little to no stress. 2 3 - A moderate amount of stress, depending on the day. 4 5 - My job has me stressing out basically all day, everyday. How familiar are you with exercise? I have little to no exercise experience and/or knowledge. I have little exercise experience, but I do have some knowledge about it. I have some exercise experience, but I am not the most knowledgeable. I have some exercise experience as well as knowledge. I am active enough and knowledgeable enough to be a personal trainer. How familiar are you with exercise? I don’t really remember the last time I’ve exercised. Ehh, I would say at least 2 years ago. I’ve exercised within the last couple of years, but not frequently. I do pretty good with exercise, in general, I will at least do some low intensity activities once a week. I exercise frequently, at least 2 times per week. How would you rate your overall energy? 1 - Little to no fatigue. 2 3 - A moderate amount of fatigue, depending on the day. 4 5 - An extraordinary amount of fatigue. Describe the activities in your current exercise routine (check all that may apply). I currently do not have an exercise routine. Mobility (Stretching, Yoga, Pilates, etc.) Aerobic (Walking, Swimming, Biking, Elliptical, etc.) Strength Training Anaerobic (High Intensity Exercise i.e. HIIT Workouts, Sprints, etc.) Other (please explain) Explain the activities in your current exercise routine. Have you ever worked with a (check all that may apply; if yes, provide detail): Personal Trainer Physical Therapist Chiropractor Masseuse Acupuncturist Other (please explain) Who have your worked with in the past? What are the goals you would want to achieve from an exercise program? Increase cardiovascular endurance Lose weight Relieve stress Relieve physical pain Increase range of motion (flexibility) Increase physical strength Increase energy levels Increase overall physical health Increase overall mental health Increase overall mood Other (please explain) What are the other goals you would want to achieve from an exercise program?
