Name
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First Name
Last Name
Email
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Phone
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Preferred Pronouns
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Please briefly tell me about yourself.
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What does a regular day in your life look like? What are some of your interests or hobbies that you spend time on regularly?
Have you received any recommendations or restrictions from a doctor or healthcare provider regarding physical activity?
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Why are you seeking support from Anna?
What do you hope to shift or alter through this process?
How often do you currently exercise or engage in a physical activity each week?
Walking, dancing, exercise classes or videos, gardening, etc.
Fast forward six months—or even six years—what goals would you like to have achieved, and how would you like your relationship with exercise to have evolved?
What is your primary fitness or movement goal?
By what date would you like to achieve this goal?
What is your primary motivation for achieving your goal?
How motivated are you about achieving your goal?
5 - very motivated
4 - motivated and taking steps to make change
3 - somewhat motivated and realize I want a change
2 - not very motivated
1 - not motivated
How do you currently feel about exercise or movement? What has it meant to you in the past?
Feel free to share any emotions or stories you feel are relevant.
Have you ever felt stuck or faced challenges with exercise, either currently or in the past? If so, what do you feel is currently, or has been, the biggest barriers to your success?
Do you have any accessibility needs or physical limitations Anna should be aware of to better support you?
Is there anything specific you’d like Anna to include or avoid in your program?
Do you have any exercise equipment you enjoy using and have regular access to (daily or weekly)?
for example: gym membership, group classes, bands, weights, yoga mat, etc...
Do you travel often, and if so, are you willing or able to stay active while away (e.g., hotel workouts, walks, or using other gym locations), if it aligns with your goals?
Do you currently have anyone supporting you in working toward your exercise goals (e.g., friends, family, roommate, or training partners)
If yes, how are they involved in your journey?
