fitcru Health Questionnaire - FitCru

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Health Questionnaire Form

Step 1 of 3 - Basic Info

33%

Name(Required)

First Last

Email(Required)

Date Of Birth(Required)

DD slash MM slash YYYY

Gender(Required)

Male

Female

What's your Instagram handle?

Fitness Goals

What are your main fitness goals? (Select multiple)(Required)

Fat Loss

Muscle Gain

Strength Gain

Improve Endurance

Increase Flexibility

Improve Cardiovascular Health

Enhance Athletic Performance

General Fitness & Well-being

Postpartum Fitness

Body Recomposition (lose fat, gain strength & muscle and get visible abs)

What are some other health goals you have? (select multiple)(Required)

Improve Sleep Quality

Increase Energy Levels

Reduce Stress

Improve Digestion

Manage Chronic Conditions (e.g., diabetes, hypertension, thyroid, PCOS,fatty liver, Uric acid levels)

Mental Clarity and Focus

Enhance Mobility & Flexibility

What is your activity level?(Required)

Sedentary : Little to no exercise, mostly sitting

Lightly Active : Light exercise or sports 1-3 days/week

Moderately Active : Moderate exercise or sports 3-5 days/week

Very Active : Hard exercise or sports 6-7 days/week

Super Active : Very hard exercise, physical job, or training twice a day

Workout preferences(Required)

Strength Training

High-Intensity Interval Training (HIIT)

Cardio Workouts

Yoga/Pilates

Functional Training

Mobility Workouts

Powerlifting

Plyometrics

Bodyweight Training

Circuit Training

Others

What is your precise current weight? (As of today on an empty stomach) in kgs(Required)

What is your ideal long term weight goal? in kgs(Required)

How fast do you want to reach your goal? (approx. months)

Height in cms(Required)

Waist in cms?

What is your approx. Body fat %?(Required)

Shoulders in cms?

Hips in cms?

Neck in cms?

Do you have any dietary preferences or restrictions? (Select all that apply)(Required)

Vegetarian

Vegan

Pescatarian

Gluten-Free

Dairy-Free

Keto

Eggetarian

No restrictions

Do you have any food allergies ?(Required)

What are your favourite foods ?

What are your least favourite foods or foods you avoid ?

Do you smoke?(Required)

Yes

No

Do you consume alcohol?(Required)

Yes

No

Upload your blood tests if available :

Max. file size: 50 MB.

(Please upload an image of your blood work six months from now, which includes CBC, vitamin D, vitamin B12, lipid profile, renal profile, HbA1c, and thyroid profile.)

Please upload any current prescriptions you have :

Do you have any injuries, surgeries, or medical conditions that we should be aware of?(Required)

This field is hidden when viewing the form

Please Upload your Current Progress Pictures (front, side and back with reference image)

Drop files here or

Max. file size: 50 MB, Max. files: 3.

Please Upload your current Progress Pictures (front, side and back with reference image)

Front Image

Max. file size: 50 MB.

Side Image

Max. file size: 50 MB.

Back Image

Max. file size: 50 MB.

Mental & Emotional Health

How would you rate your current stress level ?(Required)

Low

Moderate

High

Very High

How offten do you have episodes of emotional eating or binge eating ?(Required)

Rarely

Occasionally

Often

Almost Always

What are your primary sources of stress? (Select all that apply)(Required)

Work

Family

Financial

Health

Social Life

What do you do to manage stress? (Select all that apply)(Required)

Exercise

Meditation

Yoga

Hobbies

Spending time with loved ones

Professional Help (Therapy, Counseling)

Nothing

How would you rate your overall mood and mental well-being ?(Required)

Excellent

Good

Fair

Poor

How do you feel about your current body image ?(Required)

Very Satisfied

Satisfied

Neutral

Dissatisfied

Very Dissatisfied

The fitcru app is compatible with

iOS / Android

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Have a question?

+91 99302 73333

Contact us at

contact@fitcru.com

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