Personal Training Consultation Form

Personal Training Consultation Form

Please aim to complete this form in full, before your consultation call, to ensure we can fully cater our service to your specific requirements. Please allow yourself between 3-5 minutes to complete the consultation form in full. For any queries, please contact 07594 104 976 / info@firmhands.co.uk
Name*

First NameLast Name
Your Contact Number:*
Your Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What are your fitness goals, and the expected timeframes to achieve these by? Please provide a minimum of x1 fitness goal:*

Which of the above is the most important to you, and why?*
On a scale of 1 to 4 (1 - extremely low, 4 - very high) how motivated are you to achieve your current fitness goals?*

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Can you identify any obstacles which may prevent you from reaching your desired goals (i.e. professional/personal commitments, time management, mindset):*

2. Exercise History
On average, how many steps per day do you take? If unsure, please provide any regular walk-based journeys you take on a frequent basis and how long they take to complete (i.e. work commute, walking to local amenities etc):*
Do you currently undertake any regular exercise, or other physical activities? If so, please provide details and average weekly frequency:*
Have you previously undertaken any forms of exercise, or physical activities that you have enjoyed? If so, please provide more information below:*
Are there any exercise/activities which you do not enjoy taking part in? If so, please provide more information below:*
Do you suffer from any current/past injuries which might prevent you from taking part in physical activity? If so, please provide more information:*
Are you pregnant, currently trying for a baby or have any history of miscarriage?*

3. Personal Training & Exercise Targets
What are your reasons for deciding to work with a Personal Trainer? What are your expectations from your Personal Training sessions? *
How many sessions per week would you like to complete with your Personal Trainer?*
What days and times would you be available for your Personal Training sessions, on a weekly basis?*
Please provide days and times
Which type of service would you be most interested in:*

Indoor Training (your home/garden)Indoor Training (Gym)Outdoor Training (Nearby Parks)Mixture of the aboveOther
Please provide reasons for the above preference:*
In addition to Personal Training sessions, how many training sessions are you able to commit to on your own per week?*
How much time will you realistically have per self-training session?*

4. Nutrition
Are you following a specific eating regime? (If yes, please provide more information below): *
Do you have any specific dietary requirements? (If yes, please provide more information below): *
How would you best describe your current diet (please choose 1):*

Balanced / HealthyUnhealthyMixture of Both
On a scale of 1 to 4 (1 - extremely unhappy, 4 - very happy) how happy are you with your current diet?*

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How many units / litres of the following fluids do you drink per day on an average:*

	Daily average (can be in Units / Cups / Glasses / Litres)
Water
Tea
Coffee
Alcohol
Other (please specify)

Do you add milk, sugar or other additions to your hot drinks? If so, please provide more information:*
How many pieces of fruit and vegetables do you consume on a daily basis?*

5. Lifestyle
What is your occupation?*
On average, how many hours per week do you work?*
On average, how many hours of undisturbed sleep do you have per evening?*
On a scale of 1 to 4 (1 - little/no stress, 4 - extremely stressed) how would you rate your daily stress level?*

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Please provide reasons for the above score:*
Do you smoke? If so, please advise how many cigarettes per day on an average:*
On average, how many hours per day do you spend sitting down (including work time)*
Should be Empty:

1. Fitness Goals