Personal Training Request Form

Personal Training Request
Name (required)

First Name Last Name
Email (required)
example@example.com
Phone Number
Please enter a valid phone number.
Age
Are you currently active?

Yes Sometimes No
Do you currently strength train?

Yes Sometimes No
Do you currently do cardiovascular training?

Yes Sometimes No
If you answered YES or SOMETIMES to any areas above, please explain your current workout regimen:
What are your fitness goals?
Do you have any past/ present medical concerns or injuries that limit your activity? Medications? Please explain.
Personal Training Preferences
What day(s) of the week would you like to train?

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
How many times per week do you want to work with a Personal Trainer?
What time of day would you like to train?

Early Morning Morning Afternoon Evening
What package are you looking to purchase?

Three-Month Subscription Six-Month Subscription Single (one time) Purchases of Session Package
Late Policy:

Arriving late to your session results in loss of session time.

Cancellation Policy:

- 24-hour notice is required to cancel or reschedule a session.
- A no-show will be considered a paid session.
- To cancel a session, please call the trainer directly.
- All personal training sessions must be used within three months of the package purchase date.
By checking this box and typing my name below, I am acknowledging that I have read and understand the late policy and cancellation policy.

Acknowledged
Name of

First Name Last Name
Should be Empty:

Personal Training Request

Personal Training Preferences