Consultation Form

Prenatal/Postnatal Consultation Form

Please fill in all the details and I look forward to getting started!
Full Name

First NameLast Name
Gender
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?
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.
If you have any injuries, please list them.
Do you suffer from diabetes, asthma, high or low blood pressure?
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 exercising?
Are you currently pregnant, trying to get pregnant, or have been pregnant before?
If you have been pregnant before, please list year of delivery and mode of delivery. If not applicable, please write N/A
Have you every dealt with incontinence of urine or stool?
Have you trained with a personal trainer before?
At what times during the day would you prefer to exerise?
How many days a week would you be willing to commit to exercise?
Do you prefer online/remote coaching or in-person?
Please Choose
Is it okay to post photos and videos to social media of training and/or progress photos?
Are you okay with Progress Photos (taken personally)?
What are your expectations on me as your Personal Trainer?
1.) IN-PERSON 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.) IN-PERSON 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!
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Prenatal/Postnatal Consultation Form