Focus Personal Training Client Info Form

1
Basic Information* This field is required.
Full Name
Email
Please Select
Please Select
Male
Female
Not Listed
Prefer not to say
Gender
Date of birth
Cell Phone Number
How did you hear about Focus Personal Training Studio
2
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?* This field is required.Click Yes or No
YESNO
3
Do you feel pain in your chest when you perform physical activity?* This field is required.Click Yes or No
YESNO
4
In the past month, have you had chest pain when you were not performing any physical activity?* This field is required.Click Yes or No
YESNO
5
Do you lose your balance because of dizziness or do you ever lose consciousness?* This field is required.Click Yes or No
YESNO
6
Do you have a bone or joint problem that could be made worse by a change in your physical activity?* This field is required.Click Yes or No
YESNO
7
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?* This field is required.Click Yes or No
YESNO
8
Do you know of ANY other reason why you should not engage in physical activity?* This field is required.Click Yes or No
YESNO
9
Fitness GoalsPlease check all that apply
Appearance
Cardiovascular Endurance
Flexibility
General Health
Muscular Definition
Muscular Size
Strength / Power
Confidence
Speed
Sports Performance
Stress Reduction
Toning and Shaping
Weight Loss
Other
10
Exercise History
Please Select
Please Select
I have never exercised regularly
I used to exercise regularly
I currently exercise regularly
Do you exercise regularly?
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Please Select
1 Day a week
2 Days a week
3 Days a week
4 or more days a week
How many days a week can you exercise?
Please Select
Please Select
Very Low
Fair
Average
Good
Excellent
Rate your ability to perform cardio exercises
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Please Select
Beginner
Intermediate
Advanced
Rate your experience with exercise
Please Select
Please Select
Yes
No
Have you worked with a Personal Trainer before
11
Do you have any injuries your trainer should be aware of?Please list them in detail here
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Large
Normal
Small
Ok
Ok
12
Anything else your trainer should know about your health history and fitness goals?Please type them here
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Ok
13
Cancellation Policy
14
Emergency Contact* This field is required.Who should we contact in the event of an emergency
Emergency Contact Name
Emergency Contact Relationship to You
Phone Number of Emergency Contact
Should be Empty: