Personalised Fitness & Wellness Intake Questionnaire

At Castellanox Health Consultancy, we believe in creating personalized training plans tailored to your unique goals, lifestyle, and health needs. This intake form helps us understand your background, preferences, and aspirations to provide you with the best support on your fitness journey. Please take a few moments to complete it so we can start building a plan that aligns with your body, mind, and lifestyle. Your responses will be kept confidential and will guide us in designing a program to help you reach and sustain your fitness goals.

Full Name

Birthday

Gender

Phone

Email

Emergency Contact Name and Number

Full Name

Phone

Health and Medical History

Do you have any current or past injuries, surgeries, or chronic health conditions?

Yes

No

If yes, please specify

Are you currently on any medication that may affect your physical activity?

Do you experience any pain or discomfort in specific areas (e.g., knees, back, shoulders) during exercise?

Any family history of chronic health conditions (heart disease, diabetes, etc.)?

Fitness Experience and Current Activity Level

How would you rate your current fitness level?

Sedentary

Beginner

Intermediate

Advanced

Are you currently engaged in any regular exercise? If so, please describe (frequency, duration, type).

What types of physical activities do you enjoy? (e.g., weightlifting, running, cycling, yoga, etc.)

Do you have experience with any of the following?

Have you ever worked with a personal trainer before?

Fitness Goals

What are your primary fitness goals? (Check all that apply)

What specific results are you hoping to see in the next 3 months? 6 months?

Do you have any long-term fitness or health goals (e.g., completing a marathon, maintaining weight loss, etc.)?

Are there specific areas of your body or performance metrics you'd like to focus on (e.g., strength, agility, cardiovascular health)?

Lifestyle and Daily Habits

What does your typical day look like? (Briefly describe)

What is your occupation, and does it require any physical activity or long hours of sitting?

How many hours do you usually sleep each night?

On a scale of 1-10, how would you rate your energy levels throughout the day?

What are some common stressors in your life, and how often do you feel stressed?

Do you smoke, drink alcohol, or use any other substances regularly?

How many days per week can you realistically commit to working out?

Nutrition and Dietary Habits

Do you follow a specific diet or eating pattern? (e.g., vegetarian, keto, intermittent fasting, etc.)

What does a typical day of eating look like for you (e.g., meals, snacks, water intake)?

Do you have any food allergies or intolerances?

On a scale of 1-10, how would you rate your current diet in terms of nutritional quality?

Are you open to making changes to your diet to achieve your fitness goals?

Motivation and Mindset

On a scale of 1-10, how committed are you to achieving your fitness goals?

What motivates you to pursue fitness and health?

Have you faced any challenges or setbacks in the past when trying to achieve your fitness goals? If so, what were they?

Do you have any potential obstacles (work schedule, family commitments) that might make it difficult to stick to a plan?

How would you like your trainer to support you in staying accountable (e.g., regular check-ins, reminders, motivation)?