Facebook
[email protected]
Home
About
Move, and Move Well!
Meet Jenna Anderson
FAQ
Fascial Stretch Therapy
Training
Movement Coaching / Personal Training
Online Training Questionnaire
Blog
Book Now
Contact
Search
Menu
Menu
Experience Movement Self-Assessment Survey
Name
(Required)
First
Last
Email
(Required)
Phone
Age
Gender
Male
Female
Height
Weight
What are you looking for to get your wellness journey going?
Select one.
I have an injury, chronic pain, or limited range of motion.
All is well, I just want to be better in the gym and get more out of my fitness and health.
What have you done that has helped your pain?
What makes it worse?
How did the pain/injury/limitation come about? Just a brief history.
What results would you like to see?
At your worst, how does your pain affect your life?
At your best?
What option best describes what type of health and wellness goals you have?
Select one.
Lose weight as fast as possible.
Be healthy and fit, but I'm not worried about the scale.
I've plateaued and want to get past it.
I just want to pump weights.
What is your biggest obstacle from getting to your goals?
What have you tried without success in the past?
On a scale of 1 to 10, 1 being "I just want to sit on the couch and eat Cinnabons" and 10 being "I'll eat blended chicken and hunt Unicorns everyday if that's what it takes", how committed are you to achieving your fitness goals?
1
2
3
4
5
6
7
8
9
10
Short Answer Questions
Tell us a little more about you.
In your ideal life what does your body feel like? Move like? What activities do you do?
What do you feel like stops you from doing those now?
If there was a strength move you’ve always dreamed of doing (handstand, splits, max back squat, etc) you’ve always dreamed of what would it be?
When were you the happiest and most content in your life?
Just For Fun
Do you have pets? What are they and what are their names?
What is your favorite book/blog/podcast?
(Blank) is life. What can't you live without? (mine is coffee.)
Almost There
Just a few more.
Have you ever worked with a wellness coach before? What were your favorite parts? What did you dislike?
If calories weren’t a thing, what would you eat everyday without thinking twice?
Are you willing to invest $75-$185 and time daily to achieve your movement goals?
Select one.
Hell yes, get out of my way and bring it on!
Maybe, but I have more questions.
Yeah, no. It sounds great, but adventures can be scary. I'll stay at home.
Nice Work!
Thanks for sharing. Now press Submit.
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
Scroll to top
