Personal Training Consultation Questionnaire

Please only fill out this form if you're serious about training with me. Thank you.
Full Name*

First NameLast Name
MaleFemale
Date of Birth*

MonthDayYear
Age
years
Height
cm
Weight
KG
What do you do for a living?
none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
RarelyA few times a yearA few times a monthWeekly
Please list the physical activities that you participate 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.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
YesNo
YesNo
YesNo
YesNo
if yes please list:
YesNo
low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
12345678910
Improved healthImproved enduranceIncreased strengthIncreased muscle massFat loss
What is your goal with your training?
Why?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

How often are you willing to train a week to reach your goal?
12345678910
YesNo
YesNo
If yes what kind of training did you do:
Please note I work on shift and cannot train within these times. The following times I cannot train you are as follows:

Monday - 4-8pm

Tuesday - 4-8pm

Thursday - 6-10am

Friday - 4-8pm

Sunday - 12-4pm

All available PT slots can be found on my Calendly link, these times are updated and need to be requested in adv. I can send to you once this form is filled out.
MorningMid-DayAfternoonEvening
How often do you want to do Personal Training a week?
Please Choose
What are your expectations on me as your Personal Trainer?
Email
example@example.com
Phone Number (optional)

Area CodePhone Number
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.
YesNo
Should be Empty: