Level One Fitness Client Assessment Form

Personal Training Client Assessment

Please complete the information below
Full Name*

First NameLast Name
DOB

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
MEDICAL HISTORY
Have you had any family history of chronic disease (heart disease, diabetes, etc.)?*
If yes, please list
Have you ever been diagnosed or treated for any chronic disease including asthma?*
If yes, please list
Are you currently taking any medication?*
If yes, please list
Any other conditions that we need to be aware of (i.e. Past or present injuries, etc)?*
If yes, please list
PERSONAL DETAILS
If you have answered YES to any of the above questions, you must obtain a medical clearance prior to carrying out a physical exercise program.
HEALTH RELATED BEHAVIOURS
Do you smoke?*
If yes, how many a day?
Do you drink alcohol regularly?*
If yes, how much per week?
How many times on average do you eat fast food per week?*
How many hours of sleep do you normally get per night?*
PSYCHOLOGICAL
Please rate the following. One star being negative to five stars being positive
I have a positive attitude towards things
My job stresses me out.
I am in the best shape of my life.
I would rate my current health.
I am serious about acheiving my goals
GOALS
Do you have any health related goals (i.e. Lower blood pressure, etc)?*
If yes, please list
Do you have specific goals related to body composition (i.e. weight loss, build biceps etc)?*
If yes, please list
Do you have any performance specic goals (i.e. Increase 10km run, increase chest strength, etc.)?*
If yes, please list
Do you wish to achieve any of these goals in a specific time frame?*
If yes, please explain
LIABILITY WAIVER Please read carefully before submitting form.
I agree, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in physical activity with Level One Fitness. Having such knowledge, I hereby release , their representatives, agents, and successors from liability for accidental injury or illness, which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program. I agree to disclose any physical limitations, disabilities, ailments, or impairments that may affect my ability to participate in said fitness program.
Please tick box in agreement to the above liability waiver*

I Agree

SELECT YOUR TRAINER

View the trainer profiles below to select a trainer that best fits your fitness goals.
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Email
example@example.com
Thank you for taking the time to complete the client assessment form at Level One Fitness! We appreciate your commitment to achieving your fitness goals, and we're excited to be a part of your wellness journey.

Your dedication to kickstarting this journey by providing us with valuable information is the first step towards a healthier, stronger you. Rest assured that your details are in safe hands, and we are working diligently to match you with the perfect personal trainer who aligns with your fitness aspirations.

Within the next 48 hours, one of our experienced trainers will reach out to you to discuss your goals in more detail and to answer any questions you may have. They are eager to create a personalized fitness plan tailored to your unique needs.

In case you don't receive a response within the specified time frame, please don't hesitate to give us a call at Level One Fitness at 832-203-8875. Your satisfaction is our priority, and we are here to assist you every step of the way.

Once again, thank you for choosing Level One Fitness. We look forward to embarking on this transformative fitness journey with you!
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Personal Training Client Assessment

SELECT YOUR TRAINER