Online PT Consultation Form
Moassab PT
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a number you would like me to contact you on
Email
*
Please enter an email you would like me to contact you on
Instagram handle
*
Date of Birth
example: 01/01/2022
What is your goal and why?
Fill it in in as much detail as you can
What do you feel are your barriers when it comes to achieving your goal?
Are you currently doing some form of exercise? If so, what are you currently doing?
Even if it’s just steps - how many steps are you doing daily
What do you like/dislike when it comes to training as well as exercises
This is if you do any form of exercise at the moment. If you don’t just put N/A
How many sessions would you be able to commit to per week?
Something realistic as your plan will be based off this
What time do you prefer to train?
Morning/Afternoon/Evening
List any medications you are currently taking
N/A if you’re not taking any
Have you been diagnosed with any health problems?
Do you currently smoke?
What’s your current diet like?
Please be honest about this. It’ll just allow me to help you in the long run and see what we can focus on
Have you ever tracked calories? If yes, how does it make you feel?
What are your expectations of me as an online personal trainer?
Why would you like to have me as your personal trainer?
Just be honest. There’s no right or wrong answer I just want to know why you’ve decided to choose me as an online pt
When would you like to start?
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Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Have you had any previous injuries?
Additional Information/Comments
SUBMIT
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