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Tender. Love. Care Classes

TLC CLASS SURVEY

Our Tender. Love & Care Classes are a gentle, supportive movement space focused on restoring energy, improving mobility, and supporting nervous system balance through simple, intentional exercise. These classes meet you where you are on the day — with no pressure, no high-intensity or cortisol-spiking workouts, and no expectation to push beyond your capacity. Instead, the focus is on mindful movement, light exercise, and reconnecting with your body in a way that feels nourishing, grounding, and sustainable. TLC is about moving to feel better — physically, mentally, and emotionally — in a safe and supportive environment.

Your health and safety are important to us. Please complete this survey so we can best support you in your TLC journey.

Personal Information

1. Name:

2. Age and Date of Birth (D.O.B):

3. Gender:

Female

Male

Medical & Health Information

4. Have you been clinically diagnosed with any autoimmune disorder(s)? If so, please specify.

5. When were you diagnosed?

6. Are you pregnant?

Yes

7. Do you have any other medical conditions?
If so, please list them:

8. What medications are you currently taking?

Current Health & Lifestyle Patterns

9. Common symptoms- What are your most common side effects or symptoms?

10. Symptom severity- On a typical day, how would you rate your overall symptom severity?
(0 = no symptoms, 10 = severe symptoms)

11. Energy levels- How would you describe your average daily energy levels?

low

Moderate

High

Unpredictable/ Fluctuates

12. Exercise response- How does your body typically respond after exercise?

I feel better

I feel worse / fatigued

It depends on intensity

Unsure

13. Exercise response- What type of exercises do you feel you respond to best?
(select all that apply)

Low heart Rate Cardio Training (Zone 2)

Strength Training

HITT Training

Stretching and mobility

Anything slow and controlled

14. Trigger factors- Have you noticed any factors (such as foods, exercise, stress, sleep, or environment) that tend to trigger or worsen your autoimmune symptoms or flare-ups?

15. Stress levels- How would you describe your current stress levels?

Low

Moderate

High

Overwhelming

16. Sleep quality- How would you describe your sleep quality?

Good

Fair

Poor

Highly disrupted

Fitness & Expectations

17. How would you describe your current fitness/activity level?

Sedentary (little to no exercise)

Lightly Active (1-2 times per week)

Moderately active (3-4 times per week)

Very Active (5+ times per week)

18. Do you have any injuries or physical limitations we should be aware of?
If yes (please explain):

Support & Experience

19. What are your main goals for joining TLC?

20. What type of support or coaching helps you most?
(select all that apply)

Encouragement

Structure

Education

Accountability

other

Other:

21. Are there any movements or exercises you feel uncomfortable with?

22. Is there anything else you’d like us to know to better support you?

Consent / understanding of class nature

23. I understand that TLC classes are gentle movement-based sessions and not a form of medical treatment or physiotherapy.

Yes

Thank you for sharing. This helps us create a safe, supportive and personalized experience for you.

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Signed by Storm Loots
Signed On: April 22, 2026

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April 22, 2026 8:45 am SAST

Tender. Love. Care Classes Uploaded by Storm Loots - fitness@whatthefit4gym.co.za IP 105.245.2.31