Be Me Be Healthy - Questionnaire Please enable JavaScript in your browser to complete this form.Name *FirstLastContact Number *Email *What are 3 health, wellness and movement goals that you would like to achieve in the next 6 to 12 months? *Do you currently exercise? If so how many times a week and what type of exercise do you do? *List the type of exercise, how many times a week and how long you do it for. What support would help you reach your health, wellness and movement goals? *What do you struggle with the most when it comes to exercising regularly? *E.g Motivation, time, knowing what to do, mindset Do you have any injuries or medical conditions that may effect your ability to exercise? *If yes, please list them in the above text box and give a brief description. Have you participated in any online exercise programs before? *If yes which ones and how many sessions did you do per week and how did you find it? How important is it that you make changes/improvements in your physical activity currently? Selected Value: 0 How confident are you that you can make changes/improvements in your physical activity currently? Selected Value: 0 Are you ready to make changes now? *Yes, I'm ready No, not at the moment What way would you like to receive accountability messages through out the Be Me Be Healthy program? *SMSFacebook Messanger WhatsAppSubmit