Champ City Discovery Form Discovery Questionnaire "*" indicates required fields Name* First Last Email* Phone*✓ Valid number ✕ Invalid numberAddress Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code CountryUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and 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ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsBirthdayMonth*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay*12345678910111213141516171819202122232425262728293031Year*2016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920HiddenAge HeightFeet*65437Inches*12345678910110Current Weight123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263264265266267268269270271272273274275276277278279280281282283284285286287288289290291292293294295296297298299300301302303304305306307308309310311312313314315316317318319320321322323324325326327328329330331332333334335336337338339340341342343344345346347348349350351352353354355356357358359360361362363364365366367368369370371372373374375376377378379380381382383384385386387388389390391392393394395396397398399400401402403404405406407408409410411412413414415416417418419420421422423424425426427428429430431432433434435436437438439440441442443444445446447448449450451452453454455456457458459460461462463464465466467468469470471472473474475476477478479480481482483484485486487488489490491492493494495496497498499500501502503504505506507508509510511512513514515516517518519520521522523524525526527528529530531532533534535536537538539540541542543544545546547548549550551552553554555556557558559560561562563564565566567568569570571572573574575576577578579580581582583584585586587588589590591592593594595596597598599600lb or kg.lb or kg.lbskgNon-Activity Energy ExpenditureWhat is your occupation? How many hours do you usually sit during the day at work?Choose0123456789101112131415161718192021222324How many hours do you usually stand during the day at work?Choose0123456789101112131415161718192021222324Outside of exercise, what other sports-like activities do you regularly participate in? Average Daily StepsGoals & HabitsWhat goals do you have?* Fat Loss Muscle Growth Improve Strength Improve Mobility Improve Balance Improve Conditioning Improve Endurance Increase Pull-Ups Improve Core Strength Glute Focus Power Focus Aesthetics Improve Posture Get 1st Pull-Up Run 5K Run 10K Run Half-Marathon Run Marathon Complete Ironman Complete TriathlonSelect AllWhat is one very specific goal you would like to achieve in the first 30 days?* What is one very specific goal you would like to achieve within 90 days?* Habits You Wish To Improve Bedtime Routine Begin the day with self-care No phone or email after waking up Hydrate before & after meals Eat slower Meditate after waking up Stretch after waking up Meditate before sleep Stretch before sleep Layout workout clothes before sleep Planning the next 24 hours Reduce blue-light 2 hours before sleep Mindful eating Portion control Snacking at night Binge eat in the evening Ordering food for convenienceSelect AllWhat is one specific habit, or stack of habits, you would like to start improving right away?Wake Up Gym Clothes On ExerciseLayout Gym Clothes Before BedNot Checking Phone After Wake UpSet Daily Intentions After Wake UpNot Falling Asleep To TVLate Night SnackingHydrate before & after mealsPractice Eating SlowlyCelebrate 1 Win A DayEat 1 Veg & 1 Fruit A Day Work-Related Habits You Wish To Improve I work after everyone goes to sleep I work first thing in the morning I put work as a priority before myself Notifications trigger me I lose sleep because I work late I lose sleep because I work very early Work stress impacts my sleep I never take breaks I work through lunchSelect AllWhat is one specific work-habit, or stack of work-habits, you would like to start improving right away?Hard-Stop No Work After 8pmNo Work Until Me-Time Is DoneStand For 10 Minutes For 1 Hour SittingStretch For 1 Minute Every HourEat 2 Healthy Lunches Per WeekEat 3 Healthy Lunches Per WeekEat 5 Healthy Lunches Per WeekHydrate Every Hour At WorkCore Struggle (s)If you asked why behind the why a few times over, what do you believe is a core pain point that has prevented you from reaching your goals? Nutrition · Exercise · RecoveryWhat is your biggest struggle when it comes to nutrition? Exercise History: Describe the last 2 yearsExercise History: Describe the last 30 days. What gym equipment do you have access to? Full Gym (CrossFit) Full Gym (YMCA) Dumbbells Kettlebells Single Kettlebell Squat Rack Barbell Bench Adjustable Bench Bands 40″ Big Loops Mini Bands Foam Roller Slam Ball Medicine Ball Wall Ball Swiss Ball Bosu Ball YBell TRX (Suspension Straps) Jump Rope Pull Up Bar Cable Machine Sled Battle Ropes Equalizer Dip Bars Long Sand Bag Strong Man Sand Bag Olympic Rings Box (Bench, Cooler, Tall Ledge) Treadmill Rower SkiErg Assault BikeGym Equipment (other) Favorite Types Of Exercise CrossFit Calisthenics Bodybuilding Orange Theory F45 HIIT Metabolic Conditioning Pure Strength (5, 3, 1 or 5×5 etc) Pure Power Lifting Minimal Yoga Pilates Compound & MetCon Peloton Bike Interval Running Endurance Running Stair Climber Swimming Rope Climbing Power WalkingFavorite Exercise (other) Do you have any current injuries or limitations? Yes NoPlease describe your current injuries or limitationsSleep QualityHow would you rate your sleep quality? 10 = eight or more hours of quality sleep every night. 1 2 3 4 5 6 7 8 9 10Daily EnergyHow would you describe your daily energy?Abundance of everyday!Just enough energyI feel tired on some daysLow energy everydayLittle to no energy everydayWhat brought you to Champ City? Instagram Facebook LinkedIn Twitter YouTube Advertisement Blog Article Google Referral Gift 86432
