Personal Training Consultation Questionnaire

1

Full Name* This field is required.

First Name

Last Name

2

Gender

Male

Female

3

Date of Birth* This field is required.

4

Height

Ft & inches

5

Weight

Pounds

6

I’m looking for …

8 week training program (no online check ins)

one time customized nutrition plan (no online check ins)

training program & nutrition (with weekly online check ins)

nutrition only (with weekly online check ins)

7

Are you currently taking any supplements or vitamins? If so, list which ones.

years

8

Daily activity level at your current job.

None(seated only/desk job)

Moderate (light activity such as walking)

High (heavy labor, very active)

9

Do you have any experience with counting macros?

10

How much water do you drink a day? Are there any other beverages you enjoy?

11

How often do you eat at restaurants?

Rarely

A few times a month

Weekly

More than twice a week.

12

What does an average day of nutrition look like for you?List breakfast, lunch, snacks, and dinner

13

What is your current exercise routine?including weight lifting, cardio, classes, etc.

14

Are there any exercises in particular that you don’t like?

15

How often are you willing to train a week to reach your goal?

16

What is your experience with weight lifting?

17

Do you track your daily steps? If so how many do you get a day on average?

Please Choose

18

Please describe your current fitness goals(fat loss, build muscle, etc.)

19

Do you have any injuries or limitations I should know about?

20

What’s your email?

21

We’re you referred by anyone? If so, who?