Full Name
Date of birth
Phone
*
Email
*
How often do you currently exercise?
Rarely or Never
1-2 times per week
3-4 times per week
5+ times per week
How would you describe your daily activity level?
Mostly Sedentary (almost no movement)
Light Movement (walking, occasional activity)
Active (on your feet often or regular workouts)
Very Active (intense training or physically demanding job)
Please describe any areas of your body that you experience pain or discomfort in.
What is your primary fitness goal?
Stress Relief and Breath Control
Overall Strength and Movement Freedom
Increased Resilience and Willpower
Enhance Athletic Performance and Explosiveness
Can you comfortably hold a plank position for 30 seconds?
No, I struggle to hold it
Yes, but it’s challenging
Yes, with good form
Easily for over 30 seconds
1 minute +
How confident are you in your balance and stability during exercise?
I feel unsteady and often feel like I will fall
I can manage light balance work but it’s not my strength
My balance doesn't hinder me during most exercises
I excel at balance and stability challenges
Do you regularly practice breathwork or mindful breathing techniques?
Never
Rarely
Sometimes, but not consistently
Frequently, it is a part of my routine
Are you currently training for a sport?
Yes
No
How intense do you prefer your workouts to be?
Light and easy to manage
Moderate with some challenge
Challenging but sustainable
Very intense and demanding
Are you interested in challenging yourself with advanced balance, breathwork, and resilience-building exercises?
Not at all I prefer simpler movements
Somewhat, but I'm not sure I'm ready for advanced techniques
Yes, I'm interested but I don't want it to be the main focus
Absolutely, I want to push my limits and develop warrior resilience