Interested in working with Fuck Fitness? Great! Please fill out the form below so we can make sure we’re on the same page.Basic InformationFirst Name *Please use your legal first nameLast Name *Please use your legal last namePreferred NamePronouns *Date of Birth *Email Address *Phone *Preferred Method of Contact *Please select an optionNo PreferenceTextEmailPhoneOtherOther: *Please note: while Fuck Fitness will try to use your preferred method, alternate options may be necessary.Street Address *City *State/Province *ZIP / Postal CodeCountry *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweNo AddressI do not have a permanent physical address or mailing addressHealth OverviewPhysical Activity Readiness Questionnaire (PAR-Q)NOTE: The PAR-Q is intended to be completed prior to participation in a fitness assessment or physical activity. This activity clearance is valid for 12 months from the date completed and becomes INVALID should your health change and you may answer YES to any of the following questions.Has your doctor ever diagnosed you with a heart condition or high blood pressure? *YesNoDo you feel pain in your chest at rest, during your daily activities of living, or when you do physical activity? *YesNoDo you lose balance because of dizziness or have you lost consciousness in the last 12 months? *YesNoHave you ever been diagnosed with another chronic health/medical condition (other than heart disease or high blood pressure)? *YesNoPlease list: *Do you have (or have you had within the past 12 months) a physical condition, impairment, disability, or injury that should be considered before you partcipate in or could be made worse by physical activity? *YesNoPlease list and explain: *If you have joint pain, does it feel like it’s deep inside the joint?YesNoDo you have intense, localized pain in any part of the body?YesNoDo you experience numbness and/or tingling in the limbs?YesNoAre you under the care of a physician, chiropractor, or other health care professional for any reason *YesNoPlease list and explain: *Are you currently taking any prescribed medications? *YesNoPlease list and explain: *Has your doctor ever told you that you should only do medically supervised physical activity? *YesNoAre you pregnant or expecting to become pregnant in the near future? *YesNoDo you use any of the following? *CaffeineAlcoholTobaccoAny other substance/supplement not included under prescription medicationsNone of the abovePlease answer honestly. Your answers will not be shared unless required by law.Please explain, including quantity and frequency: *Visual CodeDo you follow any specific food/diet plan? *YesNoPlease explain: *Do you have any allergies? *YesNoPlease list: *Visual CodeHow stressful is your living environment? *MinimallyModeratelyExtremelyHow would you describe your recreational activity level? *SedentaryLightModerateIntenseDo you work more than 40 hours per week? *YesNoHow stressful is your work environment? *MinimallyModeratelyExtremelyN/AHow would you describe your occupational activity level? *SedentaryLightModerateIntenseN/AHave you ever experienced food insecurity? *Please select an optionYes, currentlyYes, in the past yearYes, more than a year agoNoUnsureHow much water do you drink per day on average? *(in ounces)How would you rate your energy level in the past three months? *LowMediumHighHow would you rate your general well-being in the past three months? *PoorOk/fairGreatGoals and InterestsAre you interested in: *Personal TrainingNutritionWhat goal(s) or outcome(s) are you hoping to achieve by working with Fuck Fitness? *Visual CodeWhy is this important to you? *Visual CodeHow long have you wanted to achieve these goals? *In what time frame would you like to achieve your goal? *What will your life look and feel like when you achieve your goal(s)? *Visual CodeWhat will your life look and feel like if you DO NOT achieve your goal(s)? *Visual CodeWhat are the biggest barriers to your success? What has held you back from making changes up to this point? *Visual CodeWhy now? *Visual CodeWho do you have currently supporting you in the pursuit of your goals?On a scale of 1 to 10 (10 being MOST CONFIDENT), do you know what you need to do to reach your goal(s)? *On a scale of 1 to 10 (10 being MOST CONFIDENT), how confident are you that you WILL do it? *What would improve your confidence? *In what way(s) do you believe I can help you? *Visual CodePersonal Training-Specific QuestionsAre you interested in: *Independent fitness programmingVirtual, asynchronous fitness programmingVirtual, synchronous fitness programmingUnsure/mixHow regularly are you looking to add physical activity to your routine? *1-2 days per week3-4 days per week5-6 days per weekDailyMore than once a dayDo you find yourself to be more motivated with a structured plan that must be followed, or do you prefer more variety and freedom? *StructureFlexibilityOpen to bothIf you were to choose an activity to reduce stress, what type of activities would you prefer? *Practical and calmAdventurous and loudOpen to bothDo you prefer to exercise with conventional equipment like machines and free weights, or are you open to trying new things? *ConventionalNew equipment/techniquesOpen to bothIn the last 3 months, what recreational activities and/or exercise have you participated in, and how frequently?Are there any exercises or styles of training you are interested in trying or learning about?Are there any types of equipment or exercises that you DO NOT like or simply DO NOT want to participate in?Nutrition-Specific QuestionsHow often do you notice fluctuations in your weight?More than once a dayDailyMore than once a weekMore than weekly but less than monthlyMonthly or lessI do not observe my weightHow often do you worry about your eating habits?More than once a dayDailyMore than once a weekMore than weekly but less than monthlyMonthly or lessI do not worry about my eating habitse.g. eating the right foods, how much you are eating, etc.How would you describe your current nutritional behaviors? *Please upload a 3-day dietary log that includes all meals, snacks, drinks, vitamins/supplements, rough quantities, and any additional relevant notesChoose FileNo file chosenDelete uploaded fileAre there any additional factors that impact your diet/nutrition?Notes and AcknowledgmentsWould you like to be considered for income-adjusted rates?NoYesIs there anything else you would like the trainer to know?Personal CopyI would like a copy of my responsesAcknowledgments and Consent *I acknowledge that submission of this form does not constitute any binding agreement or contract with Fuck Fitness or its associates. I understand that depending on my answers, I may be asked to provide additional information or confirmation from a physician that I am cleared for the desired programming.I consent to receive direct communications at the information provided by Fuck Fitness for the purpose of verifying the information contained in this submission and/or establishing a training/programming agreement. I understand that my answers and information will not be shared or sold, and I may opt out of future communications at any time.SubmitSave as DraftPlease do not fill in this field.
