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ABOUT
PACKAGES
STRONG AT HOME
SHOP
BLOG
CONTACT US
STRONG AT HOME
CLIENT QUESTIONNAIRE
Training Program Questionnaire
First Name
Last Name
Email
Phone Number
Date Of Birth
Height
Weight
Gender
Male
Female
What are your primary fitness goals?
Weightloss
Muscle Gain
Improved Endurance
Increased Strength
Overall Health Improvement
Stress Reduction
Sports Performance
Do you have any existing medical conditions, injuries, or medications we should be aware of?
How would you describe your current physical activity level?
- Select -
Sedentary: Almost completely inactive. Movement is mostly limited to basic daily tasks (e.g., eating, light desk work).
Low Active: Taking roughly 5,000 to 7,499 steps daily or doing under 4 hours of light physical activity per week.
Moderately Active: Doing roughly 7,500 to 9,999 steps per day and engaging in 2 to 3 hours of intentional, moderate exercise per week.
Very Active: Taking 10,000 or more steps daily alongside vigorous physical training or sports several times a week
Body Type
- Select -
Slim/Lean
Average/Medium Build
Curvy/Plus Size
Athletic/Muscular
Where do you carry most of your weight?
Stomach/Belly
Hips & Thighs
Arms
Back
Fullbody
Not Sure
Checkbox Field
Beginner — I'm new to exercise or returning after a long break
Intermediate — I exercise occasionally but not consistently
Active — I exercise regularly (2–3x per week)
Advanced — I train hard and consistently (4+ times per week)
Do you have any dietary restrictions, allergies, or preferences?
How did you find me?
In your own words — what does success look like after 4 weeks?
What equipment do you have at home?
No equipment (bodyweight only)
Resistance bands
Dumbbells
Kettlebells
Barbell & plates
Pull-up bar
Jump rope
Yoga mat
Bench or step
Treadmill / Bike
Other
If you have dumbbells — what weight(s)?
Anything else you want Coach Courtney to know before she builds your program?
I have read and agree to the
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