Fitness Assessment Questionnaire

Fitness Assessment Questionnaire
Please answer all questions accurately and honestly to allow us to fully determine your individual needs.
Date

MonthDayYear
Date
Name

First NameLast Name
Birthday
mm/dd
Phone
Format: (000) 000-0000.
Email
example@example.com
Address
City
State
Zip
Age
Height
Current Weight
Ideal Weight
Have you ever worked with a personal trainer before?
Have you been exercising regularly for the past 6 months?
During your last program, did your progress slow dramatically after the 1st few weeks?
Do you smoke?
Do you drink occasionally?
How long did you keep your last heath club membership while not using the facility?
How often do you eat out?
Please list the habits you would most like to change?
What events in your life are coming up that will motivate you to reach your goal?
After 1 year from now you and I are celebrating your success, what does it look like to you?
Over the past 10 years, how many times have you started and stopped a nutrition and exercise regimen?
What external factors have derailed your progress in the past?

Other
In your own opinion, why did you fail to “stick with it”?
I would like to:
15. On a scale of 1-10, how serious are you about achieving your fitness goals?
Is there any injuries your trainer should be aware of?
If none, enter N/A
Release and Waiver of Liability
Kev Fit, Inc. client hereby agrees to hold harmless indemnify Kev Fit, Inc. its offers and employees for any bodily injury, accident, or property damage arising out of the equipment, training, or facilities. Client warrants that he/she has no disabilities preventing him/her from utilizing Kev Fit, Inc. fitness services.
Print Name
Signature
Date

MonthDayYear
Date

Fitness Assessment Questionnaire

Release and Waiver of Liability