Personal Training Consultation Form

Full Name*

First NameLast Name

Gender

MaleFemale

Date of Birth*

MonthDayYear

Age

years

Height

ft

Weight

If unknown that's okay

Phone Number

Area CodePhone Number

Email

How do you prefer to be contacted?

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:

Please rate your readiness for change.

What following goals does best fit in with your goals?

What is your goal with your training?

Are you currently excersising?

YesNo

How often do you want to do Personal Training a week?

Please Choose

Is it okay to post photos and videos to social media of training and/or progress photos?

YesNoOnly TrainingOnly Progress

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.

I AGREE TO THE ABOVE TERMS & CONDITIONS!*

YesNo