Readiness Evaluation

Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Phone number
Email
example@example.com
Age
years
Height
in
Weight
lbs
What do you do for a living?
Whats the activity level at your job?

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?
How active are you currently?

Not at allA few times a weekA few times a monthA few times a year
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.
How is your current mental health?
If you have any injuries, please list them.
On a scale of 1 - 10 what's your confidence level?
Have you worked with a personal trainer before?

YesNo
Do you understand that no magic pill, wrap , juice cleanse or tea will get you to where you need to be. And that hard work is ahead?

YesNo
How much are you willing to financially invest in yourself to meet your goals?

$50$100Whatever it takes
How important is the number on the scale for you?

Very importantNot important at allIndifferent
if yes please explain:
Do you have a good support system and/or person?

YesNo
Please rate your readiness for change.

12345678910
What following goals fit best with your goals? (select all that apply)

Improved healthImproved enduranceIncreased strengthIncreased muscle massFat lossFeel sexy
What is your goal with your training?

Timeline for achieving your goal.

	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?
Please rate your motivational level to do what it takes for reach your goal.

12345678910
At what times during the day would you prefer to train?

MorningMid-DayAfternoonEvening
What are your expectations on me as your Personal Trainer?
1.) CANCELLATIONS Cancellations should be made at least 24 hours in advance of a scheduled session. I understand things come up, but please be courteous of my time. Sessions cancelled less than 24 hours in advance will be charged in full to the client. 2.) LATE ARRIVALS Each session shall be 30 - 60 minutes 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.
I AGREE TO THE ABOVE TERMS & CONDITIONS!*

YesNo
Should be Empty: