Define — DASH HAUS FITNESS

The information below is required to create a custom exercise program based on a specific goal. The purpose of this phase is to clearly specify your objective, the goal you desire and must achieve.

Name

Date of Birth

Height

Weight

Body Fat %

Occupation

What do you want to achieve from this program? Use SMART goals (Specific, Measurable, Attainable, Relevant, and Time-Bound).

Ex: I want to lose 10 lbs. by -----Date---- Ex: I want to lose 3 inches waist size. Ex: I want to improve my 5 rep max deadlift by 20 lbs by ____Date_____. EX: I want to improve my 5k run by 5 minutes by ____Date_____

What or who is suffering from not having your goal accomplished

Example: I can't go on long hikes or emotionally disturbed for not being able to lose the unwanted fat, etc.

What support do you need from your coach, family or friends to help you achieve your goal?

What external influence or obstacles do you foresee that may cause you to lose focus or completely prevent you from achieving your goal?

What type of exercises do you enjoy doing?

Ex: Conventional body building, Crossfit, light circuit training, power lifting, etc...

What types of exercises do you dislike?

Do you experience any pain or discomfort during movement or exercise? If you answered yes, please specify.

Additional comments or concerns?