Client Consultation Form

Client Consultation Form

J Mack Personal Training
Full Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Gender
Date of Birth (D.O.B)

DayMonthYear
Occupation
Please answer the following questions as honestly as possible
At present how would you best describe your current fitness level?
At present how would you best describe your current activity level?
At present how would you describe your current body weight/ body image?
At present how would you currently describe your level of motivation?
How would you describe your current experience level of the gym?
What are your goals from Exercising/Personal Training? Please provide a top 3
Please provide 3 exercises/movements you either love or would love to try out?
Please provide (if possible) any movements you would like to avoid?
What days are you available to train?
What is you preferred time of training
Health Section/PAR-Q
Have you had to consult a doctor or medical professional in the last 6 months
If you answered YES to the above, please provide details below:
Are you currently taking any form of medication?
If you answered YES to the above, please provide details below:
As far as you are aware, do you suffer or have ever suffered from:

Other
If ticked OTHER to the above, please provide details
Is there any history of heart disease in your family?
Are you currently suffering from any form of muscle or joint injury?
If you answered YES above, please provide details below:
Smoking Habits
Drinking Habits
Is there anything else which you would like to disclose/declare?
I consent and confirm that all the information provided throughout this form is currently accurate, to the best of my knowledge and ability.
Signature
Signature of Parent or Legal Guardian if the client is below the age of 18:
Date

DayMonthYear
Should be Empty:

Client Consultation Form

Please answer the following questions as honestly as possible

Health Section/PAR-Q

I consent and confirm that all the information provided throughout this form is currently accurate, to the best of my knowledge and ability.