Personal Training Consultation Form
Please fill in all the details accurately and I will be in touch!
Full Name
*
First Name
Last Name
Gender
*
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Female
Date of Birth
*
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Day
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Year
Age
*
years
Height
ft/ cm
Weight
If unknown that's okay
Phone Number
-
Area Code
Phone Number
Email
example@gmail.com
What are you interested in?
1-2-1 Personal Training
Online Coaching
Diet Plan only
Training Plan only
What do you do for a living?
What are your activity levels like?
*
Not Very Active (Spend most of the day sitting e.g. call centre, desk job)
Moderately Active (Light activity e.g. teacher, salesperson)
Active (Engage in some physical activity during the day e.g. food server, deliveries, postal carrier)
Very Active (Spend most of the day engaging in physical activity e.g. heavy labor, carpenter)
Do you follow a regular working schedule, do you work days, afternoon or nights?
Please list the physical activities that you engage in outside of the gym and outside of work:
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
List any previous injuries if so.
Are you experiencing any stresses or motivational problems?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
if yes please list:
Are you a current cigarette smoker?
Yes
No
Other (Vape, e-cig, shisha)
Which of the following goals relate to you most?
Improved Health
Tone Up
Improved Self-defence
Learn Boxing
Increased Strength
Increased Muscle Mass
Fat Loss
Weight Gain
Build Gym Confidence
What is the primary goal you are wanting to achieve?
Are you in a position to invest in your health & wellbeing?
Yes
No
TImeline for achieving your goal.
Rows
4 Weeks
8 Weeks
16 Weeks
24 Weeks
32 Weeks
40 Weeks
1 Year
Upto
Are you currently exercising?
Yes
No
Are you currently engaging in any physical activity?
Yes
No
Have you trained with a personal trainer before?
Yes
No
At what times during the day would you prefer to train?
Morning
Mid-Day
Afternoon
Evening
How often do you want to do Personal Training a week?
Please Select
1 Session
2 Sessions
3 sessions
4 or more
Please Choose
Do you consent for photos and videos to be posted on social media of training?
Yes
No
What are your expectations on me as your Personal Trainer?
1.) CANCELLATIONS Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client. 2.) LATE ARRIVALS Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client. 3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS & CONDITIONS!
*
Yes
No
CLICK SUBMIT BELOW
I will be in touch with within the next 48 hours.
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