Thee Fit Church

1
Do you exercise?
Yes
No
2

If so, how many days/hours per week?

More than 5 days, more than 10 hours
More than 3 days, 3 hours
Less than 1 day, 1 hour
3

What type of exercise?

Cardio
Weights
Recreational
All of the above
4

How do you manage stress?

I don't have stress
Ignore it/sleep on it
Exercise
5

Do you currently take anti-depressants or have you ever taken anti-depressants?

Yes - currently
No - currently
Yes - in the past
No - in the past
6

How would you rate your current nutrition?

Poor
Average
Healthy
7

What would be the most beneficial to you in helping you improve your nutrition?

8

How would you rate your overall health?

Very good
Average
Poor
9

Do you have high blood pressure or diabetes?

10

Are you on medication for a weight related illness?  If so, what illness?

11

Are you at a healthy weight?

Yes
No
12

What would be the most beneficial in helping you to begin living a healthier lifestyle?