Fitness Survey

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Fitness survey

* Indicates required field

When were you in your best possible shape? *

Under 18 years old 19-25 years old 26-35 years old 36-45 years old Over 45 years old

How committed are you to being fit? *

Very committed Somewhat committed Not committed

Are you motivated to work out on your own? *

Yes No

Do you have family and friends who actively motivate you? *

Absolutely Somewhat No, I'm flying solo

How many hours per night/day do you sleep? *

8+ hours 6-8 hours 3-5 hours Less than 3 hours

Which best describes your body type? *

Popeye Olive Oil Whimpy

Current weight and height. *

Describe your eating habits over the last 3 days. Include as much detail as possible such as quantities, timing of meals and beverage choices. *

Describe your key objectives. Include any expectations you have around how long you think it will take to achieve your goals. *

Do you have any medical conditions, (heart disease, stroke, etc.) that would limit you from working out? *

Are you taking any beta blockers, or any other types of medications? *

Name *

First

Last

Phone Number *

Email *

Submit

Positive thoughts bring about positive actions, Negative thoughts bring about negative actions.
Chose wisely. Stay focued and stay motivated.

The Team at Operation Shape Up want you to succeed. Stay well and stay FIT!