CG Training Coaching Application Form

Part 1. Basic information
Email*
example@example.com
Phone Number*

Area CodePhone Number
Personal Training Consultation Questionnaire
Full Name*

First NameLast Name
Gender

MaleFemale
Date of Birth*

MonthDayYear
Age*
years
Height*
ft
Weight*
in
Part 2. Lifestyle Information
What is your occupation?
What is the activity level at your job?

None(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Please list the physical activities that you participate in outside of the gym and outside of work.:
Part 3. Goals
Please rate your readiness for change.

12345678910
What following goals best describes your objective?

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

Part 1. Basic information