Fitness Assessment

Please fill out all required fields to complete your assessment.

Personal Information

Name *

Email *

Phone Number *

By entering your phone number, you are agreeing to receive messages from The Truth System.

Date of Birth

Height (inches)

Weight

Unit

Gender

State

City

Zip Code

Program Information

What Type of program are you looking for?

Please explain in more detail on the type of program you are looking for.

What is your preferred budget range that you can comfortably invest in yourself?

EXERCISE

What exercise activities do you currently take part in (e.g., running, weightlifting, group exercise, etc.)?

How many days per week do you get at least 60 minutes of moderate-intensity exercise?

On a scale of 0 to 10, how important is weight loss to you?

On a scale of 0 to 10, how important is sports performance to you?

DIET

On a scale of 0 to 10, how important is health improvement to you?

On a scale of 0 to 10, do you consider your overall diet to be healthy?

Are you currently following any kind of diet? If so, what diet and for what reason(s)?

How would you rank your daily salt intake?

How would you rank your daily sugar intake?

How would you rank your daily fat intake?

On a scale of 0 to 10, how effectively are you able to control your temptations for junk food?

How many alcoholic drinks do you consume per week?

Do you consume caffeinated beverages such as coffee, tea, soda, and/or energy drinks? How many per week?

LIFESTYLE

Do you feel like you get enough sleep and wake up feeling rested each day?

On a scale of 0 to 10, how would you rate your average level of stress?

What techniques do you currently use to manage your stress levels?

Do you smoke tobacco or use a vaporizer alternative?

OCCUPATION

What is your occupation?

Does your occupation require extended periods of sitting? (If YES, please explain.)

Does your occupation require repetitive movements? (If YES, please explain.)

Does your occupation require you to wear shoes with a heel? (e.g., dress shoes, work boots)

RECREATION

Do you partake in any recreational physical activities (golf, skiing, etc.)? (If Yes, please explain.)

Do you have any additional hobbies (gardening, fishing, music, etc.)? (If YES, please explain.)

MEDICAL

Please list out any past musculoskeletal injuries:

Please list out any past surgeries:

If you have experienced injuries or surgeries, were they properly rehabilitated and did you receive clearance from a doctor to return to physical activity?

Do you have any chronic health conditions (such as, but not limited to, cardiovascular disease, pulmonary disorders, hypertension, diabetes, or cancer)? (If YES, please explain.)

Are you on any medications, and if so, have you received clearance from your doctor to take part in physical activity?

Waiver & Agreement

Acknowledgment and Assumption of Risk

I, the undersigned, acknowledge that I am voluntarily participating in fitness coaching services provided by The Truth System. I understand that these services may include physical exercise and activities, and I am aware that participating in such activities involves inherent risks, including but not limited to injury, soreness, or even more serious conditions.

Health Disclosure

I affirm that I am in good health and have no physical or medical conditions that would contraindicate my participation in a fitness program. I have disclosed any relevant health conditions to the Coach and will update them if my health status changes.

Waiver of Liability

In consideration of being permitted to participate in the fitness coaching services, I hereby waive, release, and discharge The Truth System, its officers, employees, agents, and representatives from all claims, demands, or causes of action that may arise from any injury, damage, or loss sustained during or because of participating in the fitness coaching services.

Indemnification

I agree to indemnify and hold harmless The Truth System from all claims, demands, or causes of action, including legal fees, arising out of my participation in the fitness coaching services.

No Guarantees

I understand that the Coach makes no guarantees regarding results or outcomes from the fitness coaching services. My progress is dependent on my adherence to the program and my personal efforts.

Confidentiality

I consent to the use of my personal and health information solely for the purpose of providing fitness coaching services and understand that my information will be kept confidential in accordance with applicable privacy laws.

By signing below, I confirm that I have read and understood the above information, and I agree to the terms and conditions outlined in this waiver.

Clear signature *