Personal Training Consultation Questionnaire

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Date of Birth

MonthDayYear

Gender

Are you looking for fitness coaching or Muay Thai coaching?

What do you do for a living?

Whats the activity level at your job?

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 have any injuries, please list them.

Are you experiencing any stresses or motivational problems?

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

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

Please list:

Are you a current cigarette smoker?

What following goals does best fit in with your goals?

What is your goal with your training?

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?

Have you trained with a personal trainer/coach before?

If yes, what kind of training did you do?

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

How often do you want to do train a week?

Please Choose

What are your expectations on me as your trainer/coach?

Let me know a good time where we could schedule your complimentary consult session

Date

Hour MinutesAM/PM Option

Please read before hitting submit:

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 once training agreement has been made.

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. There is only a 15 min grace period for lateness. If client does not give a heads up about running late within grace period or does a no show, then session will be counted with no refund for that session lost.

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!

Personal Training/MT Private Lesson Inquiry Form