Fitness Assessment

At RAW, we want to help you achieve your fitness goals. Please fill out this form as honestly as possible and we’ll be in touch to start working on a plan to improve your health and fitness.

Your Name (required)

Your Email (required)

Your Phone Number

What are your fitness goals? Choose the top 3.
Improved HealthSports SpecificIncreased PowerImproved EnduranceIncreased Muscle MassWeight GainFat LossImproved Strength

Exercise History
BeginnerIntermediateExperienced

Do you currently exercise 3x per week?
yesno

Are you willing to spend a minimum of 30 min each day preparing meals?
yesno

Do you have trouble falling asleep at night?
yesno

Do you have difficulty waking up in the morning?
yesno

Do you sleep less than 8-9 hours a night?
yesno

Do you wake up once or more in the night?
yesno

If you do wake up, what time is it?
1-3am3-5amWake up tired at 5am

Do you sleep in a room with any light or noise?
yesno

Do you wake up feeling tired?
yesno

Do you wake up only with an alarm?
yesno

Do you go to bed later than 11pm?
yesno

Do you wake up earlier than 6am?
yesno

Do you use medications to help you sleep?
yesno

Lifestyle

What do you do for a living?

What is the activity level of your job?
None (seated work)Moderate (light activity like walking)Hight (heavy labor, very active)

Does your job involve shift work?
yesno

If you work a regular schedule, when do you work?
MorningsDaysNights

Additional Comments

RAW Personal TrainingFitness Assessment