Personal Training Consultation Questionnaire
Part 1. Basic information
Full Name
First Name
Last Name
Gender
Male
Female
Date of Birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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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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Year
Age
years
Height
cm
Weight
Lbs
Email
example@example.com
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?
None (seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
How often do you travel?
Rarely
A few times a year
A few times a month
Weekly
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. This can include current supplements.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Current Pain Level? Please include location and pain scale 1-10.
Are you experiencing any stresses or motivational problems?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
How many meals do you eat per day?
Have you ever tracked calories before? If so, how many calories do you currently consume?
Part 4. Goals
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
What following goals does best fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
What is your goal with your training? Why?
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?
Please rate your motivational level to do what it takes for reach your goal.
1
2
3
4
5
6
7
8
9
10
Do you have access to a gym? If so what kind of gym please include name and style of training.
Are you currently exercising regulary (at least 3x per week)?
Yes
No
Have you trained with a personal trainer before?
Yes
No
What kind of training did you do?
At what times during the day would you prefer to train?
Morning
Mid-Day
Afternoon
Evening
Other
What are your expectations on me as your Personal Trainer?
How did find out about Dragon Coaching?
Submit
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