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Lifestyle Information Form

The following questions are meant to give us a general overview of your health lifestyle which will aid in building a personalized health/fitness program for you.  If you need help in determining caloric intake, click on Calorie Control Council's Enhanced Calorie Calculator to calculate.

    *This form is to be submitted before using Totally Sound Fitness, Inc.'s services.

Please Note:  All information is confidential and used only by Totally Sound Fitness, Inc to assist in building a personalized health and fitness program. See Privacy Statement

Physical Activity  
1. In the past year, how often have you been engaged in physical activity?
2. What types of activities do you consider fun?
3. What are your personal barriers to exercise (i.e., your reasons for not exercising?)
4. What physical activity have you been successful with in the past (liked and participated in regularly)?
5. How do you think your weight affects your daily activities?

Support

  
6. Do you feel any family, friends or co-workers have negative feelings (i.e., disapproval, resentment) toward your efforts at physical activity?
7. Is your significant other or a close friend involved in any regular physical activity?
Occupation/Leisure  
8. What is your present occupation?
9. Does your occupation require much activity (i.e., walking, getting up and down, carrying things)?
10. What are your usual leisure activities?

Stressors

  
11. What types of things make you feel stressed?
12. How do you deal with your stress normally?

Dietary Patterns

  
13. How many meals and or snacks do you have per day?
14. What would you estimate your caloric intake to be per day?
15. Do you feel you eat healthy "most of the time"?

Expectations

  
16. Specifically describe what you would like to accomplish through your fitness program during the next:
1 month:
4 months:
1 year:
First Name:*  
Last Name:*  
Email Address:*  
Phone:  (000-000-0000)*  

  * Required Fields
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Please note: All information collected is confidential and used only by Totally Sound Fitness, Inc. to assist in building a personalized health and fitness program.

  privacy statement

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Totally Sound Fitness, Inc, serving the Greater Seattle, Bellevue, Redmond, Kirkland, Issaquah and Eastside areas. Personal fitness training, nutritional counseling, customized one on one exercise workouts by an ACE certified professional personal fitness trainer.
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