Personal Training Interest Form

Personal Training Interest Form
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
FemaleMaleNon- BinaryPrefer Not to SayTransgenderOther
Date of Birth*

MonthDayYear
Age*
years
Height (Inches)*
Inches
Weight (Approximate)*
LBS
What do you do for a living?
Sedentary (little movement, mainly seated)Moderate (light activity such as walking)High (lots of movement, very active)
Please list any physical activities you participate in (Ex. Walking, Team Sports, Hiking) or put "N/A"
3 or more2-3Once
PescetarianVeganVegetarianLactose intolerantNut allergySeafood allergyOther
YesNoUnsure
YesNo
YesNo
If you have any diagnosed health problems list them below, or put "N/A".*
If you have any previous or current pains/injuries, please list them or put "N/A"*
YesNo
Please list:
1-2x a week3-4x a week5-6x a weekEveryday
Rarely (2 drinks max)Socially (2-4 drinks max)Moderately (4-6 drinks max)Frequently (6 or more drinks)
Yes, currentNo, formerI have never been a smoker
Improved overall healthImproved endurance/ stamina/ heart healthIncreased strengthIncreased muscle massFat lossBetter nutritionBetter sleepStop chronic painImprove mental health
Why do you want to do this?
1 I'm not ready2345 I want to but I'm not fully ready678910 I am mentally and physically ready
YesNo
What kind of training did you do? (Cardio, Strength, Athletic etc)
ChestShouldersBicepsTriceps (Underneath arm)Upper BackLower Back (Love Handles)Core/ Lower AbdomenGlutes/ HipsUpper Legs (Thighs, Quads, Hamstrings)Lower Legs (Calves/ Ankles/ Feet)Balance/ Agility/ SpeedMobility/ Posture/ Flexibility
What are your expectations of me as your Personal Trainer?
Should be Empty: