Lifestyle Questionnaire

Lifestyle Questionnaire

Once you have filled this out we would like you to print it out and save it. (Printer Friendly)

This lifestyle questionnaire will assess your level of activity. The purpose of this questionnaire is to find out what level of program to start with. Add up all of the points and figure out your score to see where you fit in.

1. In the past 3 months, how often have you been involved in physical activity?
3+ times per week (6pts)
Once per week (4pts)
Once per month (2pts)
Once per 6 months (1 pt)

2. How often have you worked with resistance training (working with weights or body weight) ? I currently train....

4-6 days/week (9 pts)	Once /Month (3 pts)
3 days/week (6 pts)	I use to train 1+ year ago (2pts)
Once/week (4 pts)	I dont train (1 pt)

3. Rate your stress level. (Value 1-5 pts) (5 being NO stress)

4. How many meals do you have per day?
5+ meals (smaller meals) (5 pts)
3-4 meals (3 pts)
2 meals (1 pts)
0-1 meal (0 pts)

5. Do you feel you eat healthy “most of the time?” (55% carbs, 20% protein, 25% fat)

Enter a number 1-10 (use this value) (10 being healthy)

6. Is your Body Mass Index in the normal zone? (BMI Calculator)
Yes (5 pts)
No (-4 pts)

We will calculate your results.

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