Call Karma Lewis - Personal Trainer in Austin TX - 727-482-1200 | (512) 288 - 4469

Are you serious about losing weight and getting in shape once and for all? Don't waste time & money at the big impersonal gyms.
At Karma's Passion4Fitness we will develop a plan just for you so you see the results you want...
FAST!!

If you are ready to lose fat, tone up & feel great about yourself, Call now.
Karma's Passion4FITNESS

(512) 288 - 4469

Personal Fitness Survey

Please complete the form below so we can have a better idea of how to best meet your needs. We will contact you soon after receiving the form results.

About You
1. Name: 2. Email Address: 3. Phone (optional): 4. Gender Male Female
5. Age range 18-25 26-35 36-45 46-55 56-65 Over 65
6. Where do you live City: State:
7. height/weight height: weight:
8. Current condition of your body Under-weight Average Slightly overweight Over-weight Greatly over-weight
9. Do you have high blood pressure, asthma or other chronic breathing problem, back problems, arthritis or other condition that could interfere with your ability to exercise? Yes No
10. Do you smoke? Yes No
11. Are you currently taking any medication that could interfere with your ability to exercise strenuously? Yes No
Current exercise habits
12. Approximately how many minutes per week do you currently spend in some type of strenuous exercise? Less than an hour per week 60-90 minutes per week 90 minutes – 2 hours per week 2-3 hours per week More than 3 hours per week
13. How often to you engage in exercise that raises your heart rate and causes you to sweat for at least 10 minutes? Almost never 1-2 times a week 3-4 times a week More than 4 times a week
14. How often do you engage in exercise that helps you increase in muscle flexibility. Almost never 1-2 times a week 3-4 times a week More than 4 times a week
15. How often do you engage in exercise that helps you build muscle?. Almost never 1-2 times a week 3-4 times a week More than 4 times a week
16. Do you generally consider exercise to be fun and relaxing? Yes No
Your Goals
17. Select the fitness goals below that are important to you (choose 2-3) Other Goals:
18. If you had to choose one physical fitness goal to attain in the next 4 months, what would it be. Lose 10 pounds Improve cardiovascular health Lose 2 inches off my waist To feel more healthy Establish a personal fitness plan and regimen
19. Which of the following would you most likely consider doing in order to reach your personal fitness goal(s)? Pay for a personal trainer Pay for a gym membership Look for free online fitness information Purchase an in-home exercise machine
20. Which areas of personal fitness do you need the most help with? Choose 2 or 3 Other:
21. Have you ever hired a Personal Trainer before? yes no
22. What has typically been the hardest part about staying in shape? Hard to find time I dont like to exercise I cannot keep up the discipline Physical pain, injury, sickness prevents me from exercising

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Personal Fitness Survey

About You

1. Name:

2. Email Address:

3. Phone (optional):

4. Gender

5. Age range

6. Where do you live

7. height/weight

8. Current condition of your body

9. Do you have high blood pressure, asthma or other chronic breathing problem, back problems, arthritis or other condition that could interfere with your ability to exercise?

10. Do you smoke?

11. Are you currently taking any medication that could interfere with your ability to exercise strenuously?

Current exercise habits

12. Approximately how many minutes per week do you currently spend in some type of strenuous exercise?

13. How often to you engage in exercise that raises your heart rate and causes you to sweat for at least 10 minutes?

14. How often do you engage in exercise that helps you increase in muscle flexibility.

15. How often do you engage in exercise that helps you build muscle?.

16. Do you generally consider exercise to be fun and relaxing?

Your Goals

17. Select the fitness goals below that are important to you (choose 2-3)

18. If you had to choose one physical fitness goal to attain in the next 4 months, what would it be.

19. Which of the following would you most likely consider doing in order to reach your personal fitness goal(s)?

20. Which areas of personal fitness do you need the most help with? Choose 2 or 3

21. Have you ever hired a Personal Trainer before?

22. What has typically been the hardest part about staying in shape?