Part 1. Basic information
Online Training Consultation Questionnaire
Full Name
*
First Name
Last Name
Gender
Male
Female
Date of Birth
*
Please select a month
January
February
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April
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Month
Please select a day
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Day
Please select a year
2026
2025
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Year
Age
years
Height
Inches
Weight
Lbs
Your email or phone number to reach you at
Part 2. Lifestyle Information
Whats 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. Medical and health information
If you have any diagnosed health problems list the condition(s).
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Are you experiencing any stresses or motivational problems?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
if yes please list:
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
Part 4. Goals
What following goals does best fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
What is your goal with your training?
Why?
How often are you willing to train a week to reach your goal?
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Have you trained with a personal trainer before?
Yes
No
If yes what kind of training did you do:
What are your expectations on me as your coach?
Please Read The Following Terms and Conditions.
Weekly contact will be made with clients and with any questions please feel free to contact me. This 6 week training includes detailed workout plans and diet tips. Selecting yes is agreeing to 1:1 online coaching based around a 6 week time length for 80 dollars.
I AGREE TO THE ABOVE TERMS & CONDITIONS!
*
Yes
No
Submit
Should be Empty: