Personal Training Consultation Form
Full Name
*
First Name
Last Name
Gender
Male
Female
Age
years
Height
cm (If you don't know thats okay)
Weight
Kg
Phone Number
*
Email
*
example@example.com
What do you do for a living?
Admin work, labourer etc
Whats the activity level at your job?
*
Not much (Seated most of the day e.g., office, admin, reception)
Moderate (light activity such as walking)
High (heavy labor continu, very active)
Other
Whats your overall physical activity?
*
Sedentary: Little or no exercises
Light: Exercise 1-3 times/week
Moderate: Exercise 4-5 times/week
Active: Daily Exercise or Intense Exercise 3-4 times/week
Very Active: Exercise 6-7 times/week
Extra Active: Real physical job or Very intense daily exercise
High (heavy labor continu, very active)
Other
Please list the physical activities that you participate in outside of the gym and outside of work.:
E.g. Walking, Sports, Hiking
How many days per week can you train?
*
2 Days
3 Days
4 Days
5 Days
6 Days
7 Days
Other
What day(s) suit best for your rest day?
*
Any days you program
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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.
*
Are there additional therapies are being undertaken for the given injury?
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
Other
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No structure to my diet
I NEED HELP!
Please rate your readiness for change.
1
6
2
7
3
8
4
9
5
10
What is your experience in the gym?
0-1 Months
1-6 Months
6-12 Months
1-3 Years
3-5 Years
5+ Years
What do you expect from me as a coach? Please be as detailed as you can)
*
What following goals best fit in with your goals? (you may select more than one)
*
Improved fitness
Increased strength
Increased muscle
Fat loss/Toning
Other
Which of the following goals takes the highest priority?
*
Increased Strength
Increased Muscle
Increased Fitness/Cardio
Losing Fat
All are equal in priority
Other
Do you enjoy freeweights or machine stuff more?
*
Freeweights (Dumbells, Barbells etc)
Cable Loaded Machines
Plate Loaded Machines
I don't know yet
Mixture of all
Other
Any specific bodyparts you wish to prioritise in training?
My arms, tummy, legs etc
How often are you willing to go to the gym a week to reach your goals?
*
E.g. 3 times a week
Please rate your motivational level to do what it takes for reach your goal.
1
2
3
4
5
6
7
8
9
10
What cardio do you enjoy the most? (Select your favorites)
*
Running/Walking
Crosstrainer
Cycling
Rower
Circuit training
Boxing
Skipping
I dont like any cardio
Other
How confident are you in the gym?
Very confident
Kinda know what I'm doing
Dont know what I'm doing
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Personal Training
Only Fill this section in if you were looking for In person personal Training
Have you trained with a personal trainer before?
Yes
No
Do you lack motivation/discipline and need that extra accountability?
Yes
No
Yes kick my butt to the gym. no excuses
How many in-person personal training sessions would you like to do per week/fornightly? etc
Do you lack motivation/discipline and need that extra accountability?
Yes
No
Yes kick my butt to the gym. no excuses
What kind of coaching style do you prefer? (I ask is because some respond better to different coaching methods)
To be pushed hard with no messing around (Tough trainer, No Excuses, holds you accountable)
Still being pushed but a bit more easy going
Other
How do you prefer to be contacted?
Text Message
Email
Call
Other
Anything you wish to add?
Services
I will email you regarding all details with Programming, Personal Training,
Submit
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