FlexFlow Consultation Questionnaire

FlexFlow Consultation Questionnaire
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Preferred method of contact

Phone CallText MessageEmailOther
Preferred time of contact

MorningAfternoonEveningOther
Gender

MaleFemaleOther
Date of Birth

MonthDayYear
Age
years
Height
Inches
Weight
*Estimate (Ibs)
What do you do for a living?
*Optional
Whats the activity level at your job?

Sedentary (mostly seated)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?

RarelyA few times a yearA few times a monthWeekly
Which location works best for you?

Rocky Mountain Flex FitnessHome GymCommunity GymOther
Please list the physical activities that you participate in outside of the gym and outside of work:
If you have any diagnosed health problems list the condition(s).
*Please be specific. The more I know the more I can help :)
If you are on any medications, please list them.
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Are you experiencing any stresses or motivational problems?

YesNo
Has anyone of your immediate family developed heart disease before the age of 60?

YesNo
Do any diseases run in your family?

YesNo
Do you suffer from diabetes, asthma, high or low blood pressure?

YesNo
Please list:
Are you a current cigarette smoker?

YesNo
Your current diet could be best characterized as:

low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
SHARE YOUR FITNESS JOURNEY!
What are your health and wellness objectives, so we can tailor your fitness program?

AccountabilityNutritionWeight LossIncrease Muscle MassCorrective ExerciseCardiovascular ConditioningTone UpSports PerformanceLearning WeightsRehabilitation of InjuryFlexibilityIncrease Overall StrengthFunctional FitnessLifestyle ChangeMobilityRecoveryPlyometrics
What is your goal with your training?
Why?
Please rate your readiness for change.

12345678910
What is your Fitness History?

Beginner - little to no experienceIntermediate - Good Understanding of Fitness but need proper technique and new ideasExpert - A lot of experience, Wants to go to the next level
What do you value most?

Training ExperienceLocationEquipmentAvailabilityCommunity

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?
Are you currently excersising regulary (at least 3x per week)?

YesNo
Have you trained with a personal trainer before?

YesNo
What kind of training did you do?
At what times during the day would you prefer to train?

MorningMid-DayAfternoonEvening
How often do you want to do Personal Training a week?
Please Choose
What are your expectations on me as your Personal Trainer?
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client. Trainers Discretion

2.) LATE ARRIVALS

Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS & CONDITIONS!

YesNo
Should be Empty:

FlexFlow Consultation Questionnaire

SHARE YOUR FITNESS JOURNEY!