Personal Training Questionnaire

Full Name*

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

MaleFemale

Date of Birth*

MonthDayYear

Age

years

Height

ft/in

Weight

lbs

Have you had a DEXA Scan?

Yes or No

Would you like a DEXA Scan?

Yes or No

What do you do for a living?

none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)

Do you follow a regular working schedule, do you work days, afternoon or nights?

RarelyA few times a yearA few times a monthWeekly

Please list the physical activities that you participate in outside of the gym and outside of work that you enjoy.:

If you have any diagnosed health problems list the condition(s).

If you are on any medications, please list them.

What additional therapies are being undertaken for the given health problem(s)?

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury?

YesNo

if yes please list:

YesNo

Do you need help with your nutrition?

What is your goal with your training?

Why is that important to you?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

How often are you willing to train a week to reach your goal?

YesNo

When was the last time you exercised regularly?

Whats your favorite type of exercise that you enjoy?

What sport are you involved in or have been in the last year?

YesNo

If yes what kind of training did you do:

What gets in the way of you achieving your goals?

What has worked in the past?

What are you most afraid of when you think about starting this journey?

How often do you want to do Personal Training a week?

Please Choose

What are your expectations on me as your Personal Trainer?

1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will result in forfeiture of the session and a loss of the financial investment at the rate of one session.

2.) LATE ARRIVALS

Each session is between 30 min and 1 hour in length depending on what type you purchased. Sessions will not be extended due to the lateness of the client or due to interruptions caused by the client. Unless otyher arrangements have been previoulsy made with the trainer.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

4.) No personal training refunds will be issued for any reason, including but not limited to relocation, illness, and unused sessions.

5.) You must be a a member of Styles Studios Fitness and purchase a Personal Training package before you can commence Personal Training.

YesNo

PERSONAL TRAINER