JRF | Personalized Fitness Assessment

1
How would you rate your current fitness level?* This field is required.
Sedentary (little to no physical activity)
Below average (some activity, but not regularly)
Average (regular exercise, but not intensely)
Above average (intense exercise, strong and fit)
Athlete (high-level training and performance)
2
What is your primary fitness goal?* This field is required.
Weight loss
Muscle gain
Improved endurance
General fitness and well-being
3
How many days per week do you currently exercise?* This field is required.
0-1 days
2-3 days
4-5 days
6-7 days
4
How would you describe your current diet?* This field is required.
Mostly healthy and balanced
A mix of healthy and unhealthy choices
Mostly unhealthy and processed foods
Vegetarian or vegan
Others
5
What has been your biggest challenge in achieving your fitness goals so far?* This field is required.
Lack of time
Lack of motivation
Limited knowledge or guidance
Financial constraints
Others
6
On a scale of 1 to 10, how committed are you to making a change and reaching your fitness goals? (1 being not committed at all, 10 being extremely committed)* This field is required.
1 (not committed)
2
3
4
5
6
7
8
9
10 (Extremely committed)
Commitment
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Commitment
1 (not committed)
Row 0, Column 0
2
Row 0, Column 1
3
Row 0, Column 2
4
Row 0, Column 3
5
Row 0, Column 4
6
Row 0, Column 5
7
Row 0, Column 6
8
Row 0, Column 7
9
Row 0, Column 8
10 (Extremely committed)
Row 0, Column 9
7
How much have you invested in fitness programs, equipment, or coaching in the past?* This field is required.
$0-$500
$500-$1,000
$1,000-$2,000
$2,000+
8
What's your MONTHLY household income in USD?* This field is required.
Less than $2,000 per month
$2,001 - $3,000 per month
$3,001 - $5,000 per month
$5,001 - $8,000 per month
$8,001 - $10,000 per month
$10,001 - $20,000 per month
More than $20,000 per month
9
Are you willing to invest in a personalized fitness program to help you reach your goals faster and more effectively?* This field is required.
Yes, I can invest if there's a fit during the call.
No, I cannot invest right now.
10
Hello, please type in your name down below.* This field is required.
First Name
Last Name
11
What's your gender* This field is required.
Male
Female
12
How old are you?* This field is required.
18-24
25-34
35-44
45-54
55-64
65+
13
Hey {name}! Nice to meet you. What's your email?* This field is required.
example@example.com
14
Last question: what's your mobile phone number?* This field is required.
15
This is the last stage for submitting your Fitness Assessment. By ticking this box, you grant explicit written permission to receive email, voice, and SMS communication from Josef Rakich Fitness regarding your assessment and outcomes. You reserve the right to withdraw this consent at any moment. To do so, please click the unsubscribe link in our emails or reply 'STOP' to any text message you receive from us. Additionally, you acknowledge that providing this consent is not a mandatory condition for purchasing any products or services from Josef Rakich Fitness.* This field is required.Terms and conditions
Yes, I acknowledge and confirm the terms and conditions above.
16
Final question, what's your mobile phone number?Please, do not add any "+" signs or "( )" between characters.
Country Code
Area Code
Phone Number
17
PFA Score
18
Income Tier
19
utm_term
20
utm_content
21
Referrer
22
utm_source
23
utm_campaign
24
utm_medium
25
Hidden Box
26
User Agent String
27
Get Page URL
Should be Empty: