Personal Training Consultation Questionnaire

Personal Training Consultation Questionnaire
Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Age
years
Height
cm
Weight
KG
What do you do for a living?
Whats the activity level at your job?
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).
If you have any injuries, please list them.
Are you experiencing any stresses or motivational problems?
Do you suffer from diabetes, asthma, high or low blood pressure?
Please list:
Your current diet could be best characterized as:
Please rate your readiness for change.
What following goals does best fit in with your goals?
Please rate your motivational level to do what it takes for reach your goal.
Are you currently excersising regulary (at least 3x per week)?
Have you trained with a personal trainer before?
At what times during the day would you prefer to train?
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How often do you want to do Personal Training a week?
Please Choose
What are your expectations on me as your Personal Trainer?
Should be Empty: