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About
Contact
Work With Me

About
Contact
Work With Me

ARVA method Health And Fitness Questionnaire

Step 1 of 5 – _Basic Info_

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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 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*
Primary Goal*
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*
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?*
What do you do for relaxation?*
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?*

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Email

info@arvamethod.com

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