Group Fitness Training Consultation Questionnaire

1
Full Name* This field is required.
First Name
Last Name
2
Gender
Male
Female
3
Date of Birth* This field is required.
Month
Day
Year
4
Age
years
5
Height
cm
6
Weight
KG
7
What do you do for a living?
8
Whats the activity level at your job?
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
9
Do you follow a regular working schedule, do you work days, afternoon or nights?
10
How often do you travel?
Rarely
A few times a year
A few times a month
Weekly
11
Please list the physical activities that you participate in outside of the gym and outside of work.:
12
If you have any diagnosed health problems list the condition(s).
13
If you are on any medications, please list them.
14
What additional therapies are being undertaken for the given health problem(s)?
15
If you have any injuries, please list them.
16
What additional therapies are being undertaken for the given injury?
17
Are you experiencing any stresses or motivational problems?
Yes
No
18
Has anyone of your immediate family developed heart disease before the age of 60?
Yes
No
19
Do any diseases run in your family?
Yes
No
20
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
21
if yes please list:
22
Are you a current cigarette smoker?
Yes
No
23
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
24
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
25
How often are you willing to take a supplement daily to reach your goal?Scale 1-10
26
What following goals does best fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
Weightloss
27
Please rate your discipline level to do what it takes for reach your goal.
1
2
3
4
5
6
7
8
9
10
28
What is your goal with your training?
29
Why?
30
TImeline for achieving your goal.
8 WKS
16 WKS
24 WKS
32 WKS
40 WKS
1 YEAR
NOW
NOW
8 WKS
16 WKS
24 WKS
32 WKS
40 WKS
1 YEAR
31
How often are you willing to train a week to reach your goal?Scale 1-10
32
Please rate your motivational level to do what it takes for reach your goal.
1
2
3
4
5
6
7
8
9
10
33
Are you currently excersising regulary (at least 3x per week)?
Yes
No
34
Have you trained with a personal trainer before?
Yes
No
35
If yes what kind of training did you do:
36
At what times during the day would you prefer to train?
Morning
Mid-Day
Afternoon
Evening
37
How often do you want to do Personal Training a week?
1 Session
2 Sessions
3 Sessions
4 Sessions
5 Sessions
6 Sessions
7 Sessions
Please Choose
38
Take Photo
39
40
What are your expectations on me as your Personal Trainer?
41
How motivated are you to follow a meal plan
Not very motivated
On the fence
Completely motivated
6 timmar avtal 3 695 kr (615 kr/tim)
42
Small Group Fitness Package Options
$97/Month includes 4 workout sessions per week on a 12 week program
$143/Month 4 workout sessions per week on a 12 week program and 1 Nutritional Supplement
$197/Month4 workout sessions per week on a 12 week program and 2 Nutritional Supplement
43
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 be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. 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.) 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.
44
I AGREE TO THE ABOVE TERMS & CONDITIONS!* This field is required.
Yes
No
Should be Empty: