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SEM Activity Survey 1

This is a quick survey to help me create the best product I can for people like you. It shouldn't take more than a couple of minutes. I am a Physical Therapist and am currently on my own weight-loss journey.

I am looking to help people who have injuries either stay active or begin getting active, and/or provide some individualized programming for people based on their situation. My goal is to help people decrease their pain with activity and help them be able to do activities that they want like a 5k with friends or a hike with family, etc. 

Any feedback would be greatly appreciated and thank you!

Click the button below to start.

Start

Question 1 of 11

When was the last time you worked out?

A

This past month

B

2 months ago

C

3-6 months ago

D

7-12 months ago

E

More than a year ago

Question 2 of 11

If you aren't currently working out, what is the main limitation holding you back?

A

Injury

B

Time

C

Place to workout

D

Not knowing what to do

E

Other

F

I am working out and have no problems

G

I am working out and just push through pains

Question 3 of 11

If you answered "other" above, please explain. If you are pushing through pain with working out, why? Otherwise write "N/A".

Question 4 of 11

Have you had an injury in the past X amount of months?

A

1-2 months

B

3-6 months

C

7-12 months

D

No Injuries/Pains

Question 5 of 11

Why do you feel like you have been unable to hit your fitness goals (hiking, working out, being active with family, etc...)

A

Wrong program

B

Injuries happen or currently have them

C

Time

D

Money

E

I am hitting my fitness goals and am good on my own

F

Other

Question 6 of 11

If you answered "other" above, please explain or write "N/A" if you chose another answer above.

Question 7 of 11

Why do you feel like you have been unable to hit your nutrition goals?

A

Don't know where to start

B

Too many options out there and not sure which to do

C

Wrong program

D

I am doing okay

E

Other

Question 8 of 11

If someone could help you be active without pain, give advice on nutrition, and give you workout plans, from the comfort of your home, would you be willing to pay for their services?

A

Yes

B

No

C

I am good and don't need help with above mentioned things

Question 9 of 11

Gender

A

Male

B

Female

C

Other

Question 10 of 11

What is your age?

A

0-15

B

16-21

C

22-29

D

30-36

E

37-49

F

50-64

G

65 +

Question 11 of 11

Thanks you for being part of this survey. I would like to invite you to be part of my beta course on how to remain active with less pain. Would you be interested in joining in January?

A

Yes, please contact me

B

No

Confirm and Submit