Personal Training Consultation Questionnaire

Contact Information

Phone numberEmail

Full Name

First NameLast Name

Gender

Date of Birth

MonthDayYear

Age

years

Height

IN

Weight

LB

What do you do for a living?

Whats the activity level at your job?

Do you follow a regular working schedule?

Other

How often do you travel?

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.

What additional therapies are being undertaken for the given health problem(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?

Has anyone of your immediate family developed heart disease before the age of 60?

Do any diseases run in your family?

Do you suffer from diabetes, asthma, high or low blood pressure?

Please list:

Are you a current cigarette smoker?

Do you drink alcohol?

Your current diet could be best characterized as, check all that applies?

Have you ever tracked your macro's (Protein, Carbs, and Fats)

How much do you believe nutrition plays a role in your progress?

Do you wear a wearable fitness tracker such as an Apple Watch

Please rate your readiness for change.

Please select all that applies to your experience

What following goals does best fit in with your goals, check all that applies?

Where do plan to train?

TImeline for achieving your goal.

Rows	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.

Are you currently excersising regulary (at least 3x per week)?

Have you trained with a personal trainer before?

What kind of training did you do?

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

How often do you want to check in each week?

Please Choose

What are your expectations on me as your Personal Trainer?

Personal Training Package Options

Macro Coaching with Metabolic Build Package options

1.) CANCELLATIONS

Online Training Cancellations should be made at least 24 hours in advance of your next scheculed program update.

In Person Training; cancelations must be made at least 24 hours in advance of schedule training session.

2.) In Person Training; 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!