About
Contact
Work With Me
About
Contact
Work With Me
About
Contact
Work With Me
ARVA method Health And Fitness Questionnaire
Step
1
of
5
– ___Basic Info___
20%
Hidden
Product Purchased
Name
*
First
Last
Email
*
Date Of Birth
*
MM slash DD slash YYYY
Gender
*
Male
Female
Phone
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Has a physician ever denied or restricted your participation in exercise or sports activities?
*
Yes
No
Have you ever passed out, felt lightheaded/dizzy or had chest pain, during or after exercise?
*
Yes
No
Do you have any illnesses, injuries, or limitations that would prevent you from safely engaging in rigorous exercise, stretching, and strength training without in-person supervision?
*
Yes
No
Not Sure
Do you understand that you are choosing to engage in a fitness program that does not provide in-person professional supervision and that you are solely responsible for your own safety and health while engaging in training?
*
Yes
No
Not Sure
Height (Inch)
*
Current Weight (Lbs)
*
Ideal Weight (Lbs)
*
Daily Activity Level
*
Sedentary (Desk Job, No Activity)
Moderate (Exercise in some form 2-3 times per week)
Active (Exercise Regularly & Active Job)
Primary Goal
*
Select
Lose Weight
Body Recomposition – Maintain Weight
Build Muscle
Do you meet the requirements for the program you selected, including time commitment, access to training equipment, level of fitness experience, and health?
*
Yes
No
Not Sure
Do you feel confident that you will be able to follow exercise instructions, videos, tracking, and nutrition required for the program you selected?
*
Yes
No
Not Sure
What do you feel is your biggest challenge in reaching you fitness goals?
*
Please describe your primary goal around fitness and activity
*
Are you comfortable and feel you have the skills to follow the nutrition protocol included in the program you selected?
*
Yes
No
Not Sure
Please select your preferred style of eating
*
Select
Ketogenic
Paleo
Vegetarian
Vegan
No Restrictions
Check the following box if you would like a vegetarian meal plan
I would like to have a vegetarian meal plan
I would like to have a vegetarian meal plan
I would like to avoid eggs
I would like to avoid eggs
I would like to avoid dairy
I would like to avoid dairy
I would like to avoid gluten
I would like to avoid gluten
I would like to avoid tree nuts
I would like to avoid tree nuts
I would like to avoid red meat
I would like to avoid red meat
I would like to avoid shellfish
I would like to avoid shellfish
I would like to avoid pork
I would like to avoid pork
What do you feel is your biggest challenge with food and nutrition?
*
Not knowing what to eat
Self control
Planning
Other
What is your primary goal around nutrition and diet? Please explain
*
Where do you rank health in your life?
*
High priority
Medium priority
Low priority
How do you handle stress?
*
Addictive behavior: food, substances, gaming, screen time, etc
Mindfulness
Avoidance
Getting support
Other
What do you do for relaxation?
*
Sleep
Read
Spend time with loved ones
Watch shows
Self care practices
Meditation
Other
How many hours of sleep do you get on a normal night?
*
7-8 hours
6-7 hours
5-6 hours
less than 5 hours
Have you been successful in setting and reaching fitness or health goals in the past? Please explain.
*
How committed are you towards reaching your health and fitness goals?
*
Very committed
Somewhat committed
Just interested in learning more
How difficult do you think it will be to reach your current health and fitness goals? Please explain
*
Very difficult
Somewhat difficult
Not very difficult
What do you foresee as the biggest obstacles in reaching your goals at this time? Please explain
*
Is there anything you would like to add?
*