
Age:
City you live in:
1. How often do you exercise? (Circle or highlight by bolding option you choose)
a. 0-1 time a week
b. 2-3 times a week
c. 4-5 times a week
d. More than 5x a week
e. Never
3. Why do you want to workout? (Circle or highlight)
a. Improve the tone of your body to improve your self confidence
b. Maintain a healthy and energetic body
c. Lose weight
d. Improve health problems
4. How comfortable are you working out? (Circle or highlight)
a. Very comfortable
b. Comfortable
c. Not so comfortable
5. Would you say you have a healthy diet? (Circle or highlight)
a. Yesb. Sometimes
c. No
7. What is BMI and why is it important?
8. What do you know about nutrition?
9. What do you want to learn about nutrition?
10. What do you want to learn about physical fitness?
11. How much water should you drink per day?
12. How many calories should a woman eat per day?
13. What do you want REACH Curves to teach you for this girl’s only program?