Online Personal Training Client Questionnaire

ONLINE FITNESS PROGRAMS

Sign up to start your fitness journey
Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Height
I.e 6’1
Weight
I.e 145 lbs
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Instagram name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any diagnosed health problems?
Are you taking any medications? If yes, please list below.
Do you have any injuries? If yes, please list below.
What are your fitness goals?
What are some of your struggles when it’s comes to fitness and maintaining healthy eating habits?
How does your current diet look like?
Do you smoke?
What is your daily activity level?

1

2

3

4

5

1 is None, 5 is High
What is your daily stress level?

1

2

3

4

5

1 is Low, 5 is High
Which of the following statements fit in with your goals?

Other
Please rate your readiness to change.

1

2

3

4

5

1 is Worst, 5 is Best
What is your ideal start date?
Where will you be working out?
How many days can you train?
Are you willing to take progress photos?
Each program will last approximately four weeks, all workouts must be completed within the four weeks as the program won’t be accessible after the time period is complete. In order to continue training after each program is completed you will have to purchase your new customized program, delays in payment will mean the program will not be created and your client portal will be deactivated. Please select “ I agree” to accept the terms.
Should be Empty:

ONLINE FITNESS PROGRAMS