Get to Know You Better!

1
Contact Information
First Name
Last Name
Please enter your email
Please enter your phone
Age
Sex
2
Do you suffer from any medical condition(s) or have been affected in past?Check all that apply
Heart Disease/Condition
Pulmonary Disease/Condition
Arthritis (Bone or Joint Problem)
Major Surgery (within last 5 years)
Hormone Disorder
Obesity
Pregnancy
Psychological Disorder
Vertigo/Balance Disorder
Notable Injury
Major Injury (within the last 10 years)
3
If any conditions on previous page are checked, please provide a brief description. ***If none were applicable, skip to next question.***
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4
Have you worked with a trainer or attempted any fitness programs (group or individual) in the past?
Please Select
Please Select
Yes
No
Please choose Yes or No
If Yes, please describe the duration of the program and when you were involved.
5
How would you describe your current level of physical activity?A workout is defined as physical activity at any elevated heart rate for a duration of at least 25 minutes.
Very Sedentary (workout 1 time per month or less)
Sedentary (workout at least 1 time per week)
Active (workout at least 3 times per week)
Very Active (workout at least 4 times or more per week)
6
Choose all workout durations that are compatible with your current work/life balance:
25-30min Workout
30-45min Workout
45-60min Workout
60-90min Workout
Other
7
Can you dedicate at least 2 to 3 days to Strength Training?
YESNO
8
In term of your goal(s), please check all that apply:
Lose Body Fat
Develop Muscle Tone
Rehabilitate an Injury / Improve Current Medical Condition
Increase Muscle Size
Nutritional Education
Kickstart an Exercise Program
Assistance to Improve an Existing Exercise Program
Sport-Specific Training
Be More Motivated and Energized
Learn New Exercises and Have Fun!
Other
9
In terms of your goal(s), please describe in short detail what you believe your current weakness(es) or what you’d like to improve most.If you cannot answer this question at the moment please feel free to skip to the next. If left blank we will work together to determine an answer 👍🏽
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10
Please select all equipment you are familiar / have prior experience with.
Standard Gym Isolated Exercise Machines (Ex. Seated Chest Press)
Barbell (Ex. Barbell Squats)
Dumbbells (Ex. Dumbbell Curls)
Standard Gym Cable Machines (Ex. Cable Tricep Pull Downs)
Long Elastic Bands (Ex. Banded Rows)
Swiss Ball (Ex. Swiss Ball Crunches)
Bosu Ball (Ex. Bosu Ball Squats)
Cardiorespiratory Machines (Ex. Treadmill)
Other
11
Please select all equipment you have access to:
Standard Gym Isolated Exercise Machines (Ex. Seated Chest Press)
Barbell (Ex. Barbell Squats)
Dumbbells (Ex. Dumbbell Curls)
Standard Gym Cable Machines (Ex. Cable Tricep Pull Downs)
Long Elastic Bands (Ex. Banded Rows)
Swiss Ball (Ex. Swiss Ball Crunches)
Bosu Ball (Ex. Bosu Ball Squats)
Cardiorespiratory Machines (Ex. Treadmill)
Other
12
Do you have and other questions or concerns that have not been discussed by this questionnaire? If not, please feel free to skip this question.
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