PERSONAL TRAINING QUESTIONNAIRE

Please fill out this questionnaire if requested by the trainer for personal training sessions.

Name

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Email: Enter Email

Required

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Gender:

Required

Male

Female

Date of Birth

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Age

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Height

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Weight

Required

What do you do for a living?

Required

Activity level at work

Required

Regular working hours

Required

Do you travel?

Required

Physical activities outside of the gym and work

Required

List any diagnosed health problems if any

Required

List of medications

Required

Additional therapies for current health problems

Required

List any injuries

Required

Additional therapies for current injury

Required

Experiencing Stress or Motivational Problems

Someone in your immediate family developed heart disease before the age of 60

Diseases run in your family

Suffer from diabetes, asthma, high or low blood pressure

Cigarette Smoker

Current Diet:

Low-Fat

Low-Carb

High-Protein

Vegetarian/Vegan

No Special Diet

Rate your readiness for change:

Improve Health

Improve Endurance

Increase Strength

Increase Muscle Mass

Fat Loss

Timeline to Achieve Your Goal: Goal Timeline

Required

If you've trained with a personal trainer before please list kind of training received: Training Experience

Required

Preferred Time of Day for Training:

Morning

Mid-Day

Afternoon

Evening

How often would you like to train per week: Weekly Schedule Preferred

Required

Cell Phone: Enter Phone Number

Required

Reason for Health Change:

Contact Information:

1. Cancellations
Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours will be charged in full to client.

2. Late arrivals

Each session shall be 50 minutes in length. Sessions will not be extended (unless time is available) due to lateness of the client or due to interruptions caused by the client.

By Clicking Submit I aggree that all the information provided is correct

Reason for Health Change: