1 on 1 In-Personal Training Questionnaire

1
Full Name* This field is required.
First Name
Last Name
2
Gender
Male
Female
3
Date of Birth* This field is required.
Month
Day
Year
4
Age
years
5
Height
In
6
Weight
lbs
7
What do you do for a living?
8
What's the activity level at your job?
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
9
Please describe, to the best of your ability, your weekly schedule.
10
Please list the physical activities that you participate in outside of the gym and outside of work.:
11
If you have any diagnosed health problems list the condition(s).
12
If you are on any medications, please list them.
13
What additional therapies are being undertaken for the given health problem(s)?
14
If you have any injuries, please list them.
15
What additional therapies are being undertaken for the given injury?
16
Are you experiencing any stresses or motivational problems?
Yes
No
17
Do any diseases run in your family?
Yes
No
18
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
19
If yes, please list:
20
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
21
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
22
What following goals does best fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
23
What is your goal with your training?
24
Why?
25
TImeline for achieving your goal.
8 WKS
16 WKS
24 WKS
32 WKS
40 WKS
1 YEAR
NOW
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NOW
8 WKS
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16 WKS
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24 WKS
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32 WKS
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40 WKS
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1 YEAR
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26
How often are you willing to train a week to reach your goal?
27
Are you currently excersising regulary (at least 3x per week)?
Yes
No
28
Have you trained with a personal trainer before?
Yes
No
29
If yes what kind of training did you do:
30
At what times during the day would you prefer to train?
Morning
Mid-Day
Afternoon
Evening
31
How often do you want to do Personal Training a week?
Please Select
Please Select
1 Session
2 Sessions
3 Sessions
4 Sessions
5 Sessions
6 Sessions
7 Sessions
Please Choose
32
What are your expectations on me as your Personal Trainer?
33
Are you ready to invest in Personal Training?
YESNO
34
Which Training Package best suits you?
12 sessions @ $125 per session -> $1,500
24 sessions @ $120 per session -> $2,880
36 sessions @ $115 per session -> $4,140
48 sessions @ $110 per session -> $5,280
35
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.

4.) NO REFUNDS

Once personal training sessions are purchased, you will not be able to get a refund on your purchase. Be ready to commit to yourself. If are not ready to commit to yourself, please do not move forward with training.
36
I AGREE TO THE ABOVE TERMS & CONDITIONS!* This field is required.
Yes
No
37
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ORDER SUMMARY
Total costUSD
12 Personal Training Sessions
1,500
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24 Personal Training Sessions
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36 Personal Training Sessions
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48 Personal Training Sessions
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Total cost
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