Personal Training Interest Form
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Gender
*
Female
Male
Non- Binary
Prefer Not to Say
Transgender
Other
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age
*
years
Height (Inches)
*
Inches
Weight (Approximate)
*
LBS
What do you do for a living?
What is your current activity level?
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"
How many meals do you normally eat a day?
3 or more
2-3
Once
Any dietary restrictions?
Pescetarian
Vegan
Vegetarian
Lactose intolerant
Nut allergy
Seafood allergy
Other
Any history of IBS? (Irritable Bowel Syndrome)
Yes
No
Unsure
Do you take a multivitamin?
Yes
No
Do you suffer from heart issues, diabetes, asthma, high or low blood pressure?
Yes
No
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"
*
Are you experiencing any stresses or motivational problems?
Yes
No
Please list:
How many times do you eat out? (Fast food, Dine in, Carryout)
1-2x a week
3-4x a week
5-6x a week
Everyday
How much alcohol do you drink a week? (Beer, Wine, Spirits)
Rarely (2 drinks max)
Socially (2-4 drinks max)
Moderately (4-6 drinks max)
Frequently (6 or more drinks)
Are you a current or former smoker? (Nicotine, Tobacco, Hookah/Vapes, Marijuana)
Yes, current
No, former
I have never been a smoker
Which of the following best describes your goals? (Choose up to 3)
Improved overall health
Improved endurance/ stamina/ heart health
Increased strength
Increased muscle mass
Fat loss
Better nutrition
Better sleep
Stop chronic pain
Improve mental health
Why do you want to do this?
Please rate your readiness for change.
1 I'm not ready
2
3
4
5 I want to but I'm not fully ready
6
7
8
9
10 I am mentally and physically ready
Have you trained with a personal trainer before?
Yes
No
What kind of training did you do? (Cardio, Strength, Athletic etc)
Select your BIGGEST problem areas. What do you want to focus on? (Choose up to three)
Chest
Shoulders
Biceps
Triceps (Underneath arm)
Upper Back
Lower Back (Love Handles)
Core/ Lower Abdomen
Glutes/ Hips
Upper Legs (Thighs, Quads, Hamstrings)
Lower Legs (Calves/ Ankles/ Feet)
Balance/ Agility/ Speed
Mobility/ Posture/ Flexibility
What are your expectations of me as your Personal Trainer?
Submit
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