Full Name
*
First Name
Last Name
Gender
*
Male
Female
Other
Email Address
*
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
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2016
2015
2014
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2012
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1920
Year
Age
*
Years
Phone Number
*
Address
What do you do for a living?
What is the activity level of your occupation
None (seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Do you follow a regular work/study schedule? Briefly outline your schedule
How often do you travel?
Rarely
A few times a year
A few times a month
Weekly
Please list any physical activities that you participate in outside of the gym and outside of work:
Do you have any family history of chronic disease (heart disease, diabetes, etc)?
*
Yes
No
If yes, please list
Do you have any current/past injuries that impact you?
*
Yes
No
If yes, please list
Have you ever been diagnosed or treated for any chronic disease including asthma?
*
Yes
No
If yes, please list
Are you currently taking any medication?
*
Yes
No
If yes, please list
Do you smoke?
Yes
No
If yes, how many per day?
Do you drink alcohol regularly?
Yes
No
If yes, how many standard drinks (roughly) per week?
On average, how many hours of sleep do you get per night?
0-3
4-6
7-8
8-10+
How many times on average do you eat fast food per week?
1-2
3-4
5-7
I generally have a positive attitude towards things
1
2
3
4
5
My job stresses me out
1
2
3
4
5
I am in the best shape of my life
1
2
3
4
5
I would rate my current health
1
2
3
4
5
I am serious about achieving my goals
1
2
3
4
5
Do you have any health related goals (lower blood pressure, improve overall health etc) ?
Yes
No
If yes, please list
Do you have any specific goals relating to body composition (muscle gain, weight loss etc) ?
Yes
No
If yes, please list
Do you have any performance related goals (increase barbell squat, improve cardiovascular endurance etc) ?
Yes
No
If yes, please list
Do you have a timeframe in mind for achieving these goals?
Yes
No
If yes, please explain
Do you consent to photo and video content of you to be posted on social media for business marketing purposes?
Yes
No
How much are you willing to invest per week into personal training services for your health and fitness?
$30 - $50
$50 - $80
$80 - $100
$100 - $200
$200+
CANCELLATION POLICY - If a session is cancelled by the client within 24 hours of the scheduled session time, the client will be charged in full for the session.
*
Yes
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 HL Fitness. Having such knowledge, I hereby release HL Fitness, 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 any said fitness program.*
*
Yes
Submit
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