New client

Getting Better Mind & Body Assessment

Before we begin, we want to understand more than your fitness goals. We want to understand what helps you succeed, what challenges you face, and how we can support your wellness journey.

Section A: Personal Information

Fields marked with * are required.

Full name*Email address*Phone number(optional)Date of birth*Preferred name(optional)Emergency contact name*Emergency contact phone*

7. Preferred training format

Section B: Physical Fitness

8. What are your primary fitness goals?

Select all that apply.

9. How would you describe your current fitness level?

10. How often do you currently exercise?

11. What would success look like for you after 90 days?

In your own words

12. Do you have any physical limitations, injuries, medical advice, or health concerns that could affect exercise?

OptionalI'd prefer to discuss this privately with my trainer.

13. Has a healthcare professional advised you to avoid or modify certain exercises?

14. Do you currently have symptoms such as chest discomfort, fainting, unusual shortness of breath, or dizziness during physical activity?

Section C: Emotional Wellness

Your emotional well-being matters. These questions help us understand how to support your training experience. You may skip questions you don't wish to answer.

15. How would you describe your current stress level?

Stress5/10

NoneExtreme

16. What challenges have been affecting your wellness lately?

Optional. Select all that apply.

17. How would you describe your typical sleep?

18. How confident do you currently feel about reaching your wellness goals?

Confidence5/10

Not at allCompletely

19. What usually helps you feel encouraged or supported?

Optional

20. Is there anything you would like your trainer to understand about your current season of life?

Optional

We don't provide therapy. If you'd like mental health support, we'll help you find a licensed professional.

Section D: Coaching Preferences

21. What coaching style works best for you?

22. When you're having a difficult day, what helps you most?

23. What would you most like to gain from the Getting Better experience?

In your own words

Section E: Acknowledgments

Each acknowledgment is separate and must be checked on its own.

I understand that fitness coaching is not mental health diagnosis, psychotherapy, or medical treatment.I understand that my trainer may recommend modifying or postponing exercise when safety concerns arise.I understand how my personal information will be collected, used, protected, retained, and deleted, subject to a separately reviewed privacy notice.My answers to the emotional wellness questions are voluntary, and I may skip them or withdraw at any time.I acknowledge that participation in exercise carries risks.I understand my answers are saved to my account, seen only by Javid, and I can ask for them to be deleted.

These acknowledgments are not a substitute for a professionally reviewed informed-consent document, liability waiver, or privacy policy.

This assessment is not a medical or mental health diagnosis. In crisis, call or text 988.