Consultation Form

Consultation Form
Name*
Age*
D.O.B*

MonthDayYear
Date
Occupation*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Todays Date*

MonthDayYear
Date
Please fill in the following details!
What are your fitness goals?*

Appearance (aesthetics)Cardiovascular enduranceFlexibilityHealth (General)Muscular definitionMuscular sizeMuscular strength/powerSelf-esteem or confidenceSpeedSports performanceStress reductionToning and shapingWeight lossPosture
Other fitness goals
Do you exercise regularly?*
Rate your ability to perform cardio exercises
Rate your experience with exercise
Have you ever worked with a personal trainer?

YESNO
How was your experience?
What equipment do you have access to?

DumbellsBarbellsCardio machinesStrength machines (Nautilus, Precor, Cybex, etc... )Cable weightsResistance bandsBosu ballsKettlebellsTRX bandsBowflex
On which days are you available to work out?*

SundayMondayTuesdayWednesdayThursdayFridaySaturday
Do you have any existing injuries, pain or conditions that I should be aware of while building your training plan?*
Do you need help with nutrition ?

YESNO
Describe when and what you eat?
How is your water intake ?*

PoorFairGreatNo idea
Do you take any medications? supplements ?*

YESNO
What do you take?*
Any other comments about what you would like to see in your fitness plan
Should be Empty: