Be Me Be Healthy – Questionnaire

Be Me Be Healthy - Questionnaire

Name *

First

Last

Contact 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? *

What way would you like to receive accountability messages through out the Be Me Be Healthy program? *