Client Questionnaire

Full Name*

First NameLast Name
Email address
Gender

MaleFemale
Date of Birth*

MonthDayYear
What’s your current activity level?

Sedentary (0-5000 daily steps)Lightly active (5000-7500 daily steps)Moderately active (7500-10,000 daily steps)Very active (10,000-12,500 daily steps)Extremely active (12,500+ steps )
What are your training goals?

Fat loss & muscle massFat lossMuscle massStrength & performanceInjury rehabilitationSports specific conditioning
How many days per week are you currently training?
How many days per week can you commit to training?
Any exercise outside of the gym?
If you have any injuries, please list them below.
Do you have any medical issues
Do you have a high stress job?

YesNo

Do you have a specific timeline for achieving your goal.

	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR	N/A

Cancellation policy

If you cancel a session within 24 hours or fail to shown up for a session for any reason (including illness) you will still be charged for that session.
I AGREE TO THE ABOVE TERMS & CONDITIONS:*

YesNo
Should be Empty: