Consultation Form
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  • Gender

  • Goals

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  • What following goals best fit in with your personal goals?

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

  • Lifestyle

  • Does it require extended periods of sitting?
  • Does it require repetitive movements through out the day?
  • Does it cause you anxiety or mental stress?
  • Would you like to recieve daily habits included with your program to help build a better fitness lifestyle?

  • Tell me about yourself

  • Do you or are you experiencing any stresses or motivational problems?
  • What is the hardest part being in the the gym for you?
  • Please rate your readiness for change.
  • Please rate your motivational level to do what it takes for reach your goal.

  • Physical Activity Readiness Questionnaire ParQ)

  • For most people physical activity should not pose a problem or hazard. The (ParQ) has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should recieve medical advisement concerning the type of activity most suitable for them. Common sense is you best guide in answering these questions. Please read them carefully and select the correct answer as it applies to you.

  • Have you ever been diagnosed with a known disease such as diabetes ,MS, Fibro, etc?
  • Has your doctor told you that you have heart trouble?
  • Do you feel pain in your chest when you do physical activity?
  • Are you over the age of 60 and not accustomed to vigorous exercise?
  • Have you had any of the following:
  • Has your doctor said your blood pressure is too high or are you taking medication for high blood pressure?
  • Do you ever feel faint or have spells of severe dizziness?
  • Are you pregnant, have serious injury, or any other medical conditions that require guidance ?
  • Do you know of any other reason why you should not do physical activity?

  • If you answered "YES" to two or more questions:

    - Complete a patient recommendation form. If you have any questions, contact Personal Trainer.If patient recommendation for is need email or contact trainer to provide you with form.

    If you answered "NO" to all the questions you are suitable for:

    -unrestricted physical activity starting off easgy and progressing gradually

    -Lifestyle Athletics will be available to assist you with a custom program suited to acheive your goals

  • 1.) CANCELLATIONS(applies to in person training only) 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 (applies to in person training only)Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.Any later than 15 minutes session will be considered a no show and client will be charged for that session 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 understand any online training will not require trainer to be there in person. Any questions or concerns i must contact trainer via Email or phone/text. Also through lifestyle athletics app .This is not a (personal training agrement), (price sheet), or any other form to collect payment. This information is to give the Lifestyle athletics personal trainer a better idea on what kind of custom program to create to help acheive desired goals.(I understand that all the information given will be kept safe and confidential, and only I ,my trainer, and physician will have access to.

  • I AGREE TO THE ABOVE TERMS & CONDITIONS!*
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