Personal Training Client Intake Form

Training Consultation Questionnaire
Part 1. Basic information
Full Name

First NameLast Name
Email
example@example.com
Gender
Date of Birth

MonthDayYear
Age
years
Height
Weight
LBS
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?
Do you follow a regular working schedule, do you work days, afternoon or nights?
Please list the physical activities that you participate in outside of the gym and outside of work
Part 3. Medical and Health Information
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any pains or injuries, please list them, and did you have gotten them treated?
Please list:
Are you a current cigarette smoker?
Are you following a Diet plan now?
If yes, what is it?
Part 4. Goals
What following goals does best fit in with your goals?
Why these goals and why now? and have you tried these goals in the past, what worked and what didn't?
How often are you willing to train a week to reach your goal?
Please rate your motivational level to do what it takes for reach your goal.
Are you currently excersising regulary (at least 3x per week)?
If yes what type of training do you do?
At what times during the day would you prefer to train?
What area do you feel you need help in the most that I can provide?
What do you like to do in your free time? What are you into? Hobbies?
Should be Empty:

Training Consultation Questionnaire