Fernandes Fit

Program Questionnaire

Full Name *

Date of Birth *

Phone *

E-mail *

Height *

Weight *

Ideal Weight *

Facebook Profile Name (for contact & Facebook group purposes)

How did you hear about Fernandes Fit? *

Male

Female

Other

Prefer not to say

What are your health and fitness goals? (Select all that apply) *

Lose weight

Live a healthier lifestyle

Tone & define your body

Increase strength

Increase muscle mass

Increase cardiovascular endurance

Other

Share 2-3 reasons why these goals are important to you. Explain why. *

What is your time frame for reaching these goals? *

1-3 months

4-6 months

7-9 months

10-12 months

12+ months

I don't know

How would you describe your current level of commitment toward pursuing your fitness goals and achieving the results you want? *

Unmotivated and NOT ready to work

Somewhat motivated, ready to work (sort of)

I'm not sure

Fairly motivated, fairly ready to work

Extremely motivated & ready to work

Why is now the right time for you to pursue improving your health and fitness?

Name 2-3 challenges and/or struggles you face that have kept you from achieving your goals. Explain why. *

What are the biggest fears holding you back, and why? *

How would you describe your experience level with health and fitness training? *

Novice (no experience)

Beginner (some experience)

Intermediate (I train but not sure what to do)

Advanced (I train and know what to do)

How would you describe your level of activity on an average day? *

Sedentary (sit at a desk all day)

Lightly active (on my feet most of the day)

Moderately active (job elevates my heart rate)

Extremely active (physically demanding job)

Where will you train? *

At home

In a public gym

Both

I travel for work and may need hotel workouts

How many days per week can you realistically invest into a health and fitness program? *

1-2

5 or more

What physical activities do you enjoy and dislike, and why? *

Do any physical activities cause you pain and/or discomfort, and why? *

What non-physical activities do you enjoy, and why? *

Do you believe your current eating habits are healthy? Why or why not? *

What nutritional plans have you followed in the past? Why did you choose those plans, and did they achieve the desired results? *

Rate your average daily stress level? (1 - no stress at all, 10 - extremely stressed all the time) *

What factors cause you the most stress, and why? *

How many hours of sleep do you get on an average night? *

Less than 4

5-6

7-8

9 or more

Rate your average night's sleep? (1 - no sleep at all, 10 - great night's sleep every time)

What factors affect your quality of sleep, and why? *

Are you ready to FINANCIALLY invest in your health and well-being? *

Yes

I'm not sure

Fernandes Fit features four (4) programs with unique price points. All require a minimum 3-month commitment required.

Please select the option below that best suits your overall health and fitness needs as well as household budget. Price points are listed per month (a 3.95% fee will be added to card payments). Other payment options (weekly, bi-weekly, paid in full) and 5-10% discounts for longer commitments are available.

You will find the programs offered below, Click the following link - https://acrobat.adobe.com/id/urn:aaid:sc:us:705e4675-fc9c-4067-91e5-eaf5fb87d61a - to learn more about each program, and contact me at 814.504.7774 or [email protected] with further questions.

Fernandes Fit Program Plans *

$100/month - Fernandes Fit Membership Program [1 group check-in call/month]

$225/month - Self-Driven Virtual Program [1 check-in call/month]

$450/month - Virtual Program [4 check-in calls/month]

$300 to $1,000/month - In-Person Training Program [30-60 minute sessions 2x-5x per week]

I cannot afford 1-on-1 coaching at this time.

Will your spouse, other family member etc. be involved in making decisions? (If we schedule a Zoom call, please have that person attend the meeting) *