Personal Training Interest Form
(NOT swim lessons)
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
First Name
Last Name
Age
*
Phone Number
*
-
Area Code
Phone Number
E-mail
*
jondoe@provider.com
Best way to Contact
*
Email
Phone Call
Text
Are you currently a member?
*
Yes
No
Are you interest in:
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Online Personal Training
In Person Personal Training
Personal Trainer Preference
*
Male
Female
No Preference
Specific Trainer
Select Trainer
*
Brad
Anna
Cameron
Allie
Hannah
Michelle
Toni
Olivia
Hannah
Seth
Jeff
Days per week you would like to meet:
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Once a Week
Twice a Week
Three times a Week
Other
What duration do you foresee yourself needing/wanting a trainer:
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One Time
A Few Weeks
3-6 Months
Until I Reach My Fitness Goals
Just Looking for More Information
Best time of day to schedule Personal Training sessions
*
5:00AM to 10:00AM
10:00AM to 2:00PM
2:00PM to 6:00PM
6:00PM to 9:00PM
How comfortable are you with the gym/working out
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Beginner
I know a little
Comfortable
Very comfortable
Prior experience with a Personal Trainer if any:
Briefly describe what you expect to accomplish through Personal Training:
*
Do you have any relevant medical conditions:
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No
Yes
Medical Conditions:
*
Please verify that you are human
*
Submit Form
Should be Empty: