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

What following goals does best fit in with your goals?

Improved health

Improved endurance

Increased strength

Increased muscle mass

Fat loss

7

Whats the activity level at your job?

none(seated only)

Moderate (light activity such as walking)

High (heavy labor, very active)

8

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

years

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?If you’re doing cardio, list what kind and how long, and how many times per week.

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

Is there any body part you want to improve on?

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?