Personal Training Consultation Questionnaire

Full Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

Gender

Date of Birth

MonthDayYear

Age

years

What do you do for a living?

Whats the activity level at your job?

Do you follow a regular working schedule, do you work days, afternoon or nights?

If you have any diagnosed health problems list the condition(s).

If you are on any medications, please list them.

If you have any injuries please list them.

What are the biggest barriers preventing you achieving your goals ?

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? If yes, Use other box to let me know.

Other

Do you suffer from diabetes, asthma, high or low blood pressure?

if yes please list:

Are you a current cigarette smoker?

Your current diet could be best characterized as:

Please rate your readiness for change. How much of a priority is it for you to change right now?

In the next 12 months time what would need to achieve in order for you to label working with me a sucess? Choose as many as you like.

Why is it so important for you to take control of your health and fitness ? (please be as detailed as possible)

Are you willing to put in the work to achieve your goals? I can only lead you, you'll still have to implement and get outside your comfort zone to achieve the results.

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

Are you willing to Train 3-5 times per week to achieve your goal?

Please rate your motivational level to do what it takes for reach your goal.

Are you currently excersising regulary (at least 3x per week)?

Have you trained with a personal trainer before?

If yes what kind of training did you do:

Are you looking for 1-1 Personal training or Online Coaching.

What are your expectations of me as your coach and from the coaching experience?

Are you willing to invest £4-10 a day in yourself to reach your goals ?

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.

I AGREE TO THE ABOVE TERMS & CONDITIONS!