Personal Training Enquiry Form

Full Name

First NameLast Name

Gender

Date of Birth

MonthDayYear

Mobile number

Email

example@example.com

Age

years

Height

cm

Weight

KG

Where did you hear about my PT services?

What do you do for a living?

Whats the activity level at your job?

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

Are you on any medication regarding to these condition(s)?

If you have any injuries, please list them, big or small.

Have you seen a physiotherapsit for the injury? if so what did they advise you to do?

Do you feel you need help with nutrition?

Do you currently track your calories?

If yes how many calories are you currently on and how much protein per day?

How many steps a day do you usually get,?

If you dont track, are you prepared to start tracking?:

Give me an example of a typical days eating for breakfast, lunch, dinner, drinks and snacks please give as much detail as possible.

Which of the following best fit in with your goals?

What is your main goal with your training and why?

What do you think has stopped you reaching your goals up to this point?

Please rate your motivational level to do what it takes for reach your goal, 1 being very unmotivated 10 being very motivated.

How many days a week can you commit to the gym to reach your goal?

What specific days can you commit to going to the gym? Tick all that apply

What time suits you best for personal training?

How often are you currently excersising?

Please detail in full all exercises you currently do in the gym including how many reps and sets for each. Don't worry if you're unsure of the exercise name just describe it as best you can!

Have you trained with a personal trainer before?

If yes what kind of training did you do and why do you feel you needed a change in personal trainer?

I, the client understand with any exercise there comes a risk of injury, therefore the personal trainer, Tracy Dunlop, cannot personally be held liable in the event of an injury occurred during use of the app by me, the client. All information given to the client should never replace that of a doctor, nutritionalist, physiotherapist or other qualified medical professional. This programme is designed with no specific medical condition in mind and therefore if I, the client has any medical condition or injury, I confirm that I have consulted with a professional for advice on my ability to undertake these exercises given. I accept full responsibility if any injury should occur to me during use of the app or during personal training sessions.

ALL THE INFORMATION I HAVE GIVEN IS CORRECT. BY PROCEEDING I UNDERSTAND AND AGREE TO THESE TERMS. I have sought and followed any necessary medical advice required prior to starting. I understand that all the information given will be kept confidential. I understand that when payment has been made there will be no refunds issued as an alternative, sessions may be defferred if necessary.

I AGREE TO THE ABOVE TERMS & CONDITIONS!