Personal Training Consultation Form

Personal Training Consultation Form

Please fill in all the details and I look forward to getting started!
Full Name*

First NameLast Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Age*
years
Height*
ft, in
Weight*
If unsure give your most accurate guess
Phone Number*

Area CodePhone Number
Email*
What do you do for a living?*
Are you looking to train IN PERSON (Long Beach, CA) or ONLINE?*

In PersonOnline
Whats the activity level at your job?

none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you currently have a gym membership or a home gym?*

YesNo
Do you follow a regular working schedule, do you work days, afternoon or nights?
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.*
If you have any injuries, please list them.*
Are you experiencing any stresses or motivational problems?

YesNo
Do you suffer from diabetes, asthma, high or low blood pressure?

YesNo
if yes please list:
Are you a current cigarette smoker?

YesNo
Please rate your readiness for change.*

12345678910
What following goals best fit in with yours?*

Improved HealthTone UpIncreased StrengthIncreased Muscle MassFat LossWeight GainBuild Gym Confidence
What is your goal with your training?*
Why?*

TImeline for achieving your goal.

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

Are you currently excersising?*

YesNo
Have you trained with a personal trainer before?*

YesNo
At what times during the day would you prefer to train?

MorningMid-DayAfternoonEvening
What are your expectations on me as your Personal Trainer?
1) Once payment for ONLINE COACHING is made I understand that it is NON REFUNDABLE

2) 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!*

YesNo
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Thank you!
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