Personal Training Enquiry Form

Personal Training Enquiry Form

Please complete this form to help me understand your needs. All information will be kept strictly confidential.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Age
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Height (cm)
Weight (kg)
What do you do for a living?
How would you describe the activity level of your job?
What activities do you do outside of work?
Do you have any injuries? If yes, please describe.
Do you have any diagnosed health problems? If yes, please specify.
Which of the following best fit your goals? (Select all that apply)

Other
Have you worked with a personal trainer before?
Rate your readiness for change

1

2

3

4

5

6

7

8

9

10

1 is Not ready, 10 is Very ready
How often would you like to do personal training per week?
Please describe your lifestyle, stress level, sleep, alcohol consumption, and smoking habits
All information provided will be kept strictly confidential.
Should be Empty: