Physical Activity Readiness Questionnaire
Congratulations! You have taken the first step towards achieving your fitness goals! The consultation form is designed to collect as much information about your fitness and activity levels as possible.This information is then used to build you tailored workout programmes that can be scheduled and built upon going forward, therefore please answer as truthfully as possible.All information is strictly confidential.
About You
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Age
Weight (kg)
Height (cm)
Body Fat % (If Known)
Unsure of BF%? Please provide your neck, waist & hip measurements below (cm)
Services
Which service are you interested in?
Please Select
30m Personal Training
45m Personal Training
60m Personal Training
1 Month Personal Training Package
Interested in Nutritional Services? (additional costs occur)
Yes
Goals
Please detail your fitness goals and what you would like to work towards in our sessions together. The more detail you can provide me with, the better understanding I'll have to be able to provide my services for you.
What do you hope to achieve from a PT? Please be as specific as possible.
Please provide me with a brief overview of your exercise history. Include previous stints of exercising, why you stopped if applicable and / or how often you exercise(d)
Availability
Please specify your best suitability for 1-1 Personal Training Sessions (Weekdays)
Rows
Evening
Monday
Tuesday
Wednesday
Thursday
Please specify your best suitability for 1-1 Personal Training Sessions (Weekends)
Rows
Morning
Afternoon
Saturday
Sunday
Please add your preferred time slots e.g. 7-8pm, 5.15 - 6pm etc.
Progression & Social
One way we can track your progress is via photos. Please specify if you would be comfortable in taking and uploading progress photos to track progress. (Photos uploaded are only seen and accessed by you and me as your trainer.)
Yes
No
Occasionally, pictures / videos of workouts are used for social media promotion. Please specify if you would be comfortable with this.
Yes
No
How did you hear about Lewis Wasley Personal Training?
Would you be happy to be contacted for reviews or testimonials?
Yes
No
Medical
Please outline any medical conditions that may affect your ability to exercise, providing as much detail as possible.
Charges
Note that bookings cancelled less than 24hrs in advance will be subject to charges at their face value
*
I agree and understand
Declaration
I take full responsibility for my health and well being during the course, including any injuries. I will inform my trainer of any medical changes which affect my ability to partake in physical exercise.
Signature
Submit
Should be Empty: