Personal Training Questionnaire

Full Name

First NameLast Name

Gender

Other

Date of Birth

MonthDayYear

Age (Optional)

years

Height

cm

Weight (Optional)

KG

What do you do for a living?

What is the activity level at your job?

What is your current fitness routine?

How many times per week do you exercise?

Do you have any diagnosed health concerns? If so, please list.

Do you have any injuries or limitations? If so, please list.

Are you engaged in any form of exercise or physical therapy for these concerns/injuries? If yes, please explain.

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

Please list:

What goals are you looking to achieve from our PT Sessions?

How do you like to be trained?

What are your overall expectations of me as your Personal Trainer?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

Please rate your motivational level to do what it takes to reach your goal.

1.) CANCELLATIONS

Cancellations must be made at least 12 hours in advance of a scheduled session. The client is responsible for notifying the Trainer of their request to cancel. If a client fails to cancel, 12 hours in advance, he/she may forfeit a package session. If the client has already used their package session, or if he/she is a drop-in user (i.e not a package holder), his/her credit card may be charged. Early cancellations (more than 12 hours in advance of class session starting time) have no penalty fees.

2.) LATE ARRIVALS / INTERRUPTIONS

Each session shall be 55 minutes in length. Sessions will not be extended 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!