• Personal Training Consultation Questionnaire

    Personal Training Consultation Questionnaire

    w/ Audra B
  • Part 1. Basic information

  • Gender*
  •  -
  • Part 2. Lifestyle Information

  • Whats the activity level at your job?
  • How often do you travel?
  • Part 3. Medical and health information

  • Are you experiencing any stresses or motivational problems?
  • Has anyone of your immediate family developed heart disease before the age of 60?
  • Do any diseases run in your family?
  • Do you suffer from diabetes, asthma, high or low blood pressure?
  • Are you a current cigarette smoker?
  • Your current diet could be best characterized as:
  • Part 4. Goals

  • Which of the following goals best fit in with yours (select all that apply)?
  • Rows
  • What personal barriers do you feel are keeping you from reaching your nutritional and fitness goals?
  • Do you currently exercise on a regular basis?
  • What equipment do you have access to?
  • What days are you available to train?
  • At what times during the day would you prefer to train?
  • Have you trained with a personal trainer before?
  • Part 5. Measurements

  • Anthropometrics (Body measurements)

  • Average Daily Activity For The Day*
  • Have you had any recent weight gain or loss?
  • Part 6. Mental Readiness/Personality

  • Please rate your readiness for change.
  •    
  • What motivates you?
  • Please Read The Following Terms and Conditions.

  • 1.) CANCELLATIONS
    The personal trainer reserves the right to charge you for a training session if you do not give at least a 24-hour cancellation notice. This session will be classified as a "NO SHOW SESSION" and will be deducted from your session balance.
    If you become aware that you cannot make a scheduled appointment, leave a detailed message at the contact number chosen by your trainer.


    2.) LATE ARRIVALS
    Each session shall be 30 minutes - 1 hour in length as initially agreed upon by the client and trainer. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.


    3.) LIABILITY
    In recognition of the possible dangers connected with any physical activity, the client hereby knowingly and voluntarily waives any right of cause of action of any kind whatsoever arising from any liability which may or could accrue to the club, its officers, agent's employees or instructors due to injury or dissatisfaction of client. Should client default, client agrees to pay all costs of collection, including agency fees, court costs and reasonable attorney fees, all of which may be paid or incurred by the holder of this note. Client agrees that no other representation is made other than that which is agreed to in writing.
    Failure to use all personal training sessions or follow program will not relieve client payment. 


    4.) 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.  

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