ODIN PT Pre-Exercise Questionnaire

Personal Training Pre-Exercise Questionnaire
The details you share in this form enable me to tailor your Initial Consultation and Goal-Setting Session to your specific needs, ensuring that you're ready for training.

Please be forthright and thorough in your responses; this will help me create the most effective training plan for you.

The form will cover topics such as your fitness goals, past training experience, current dietary habits, medical history, and lifestyle factors, as well as a liability waiver.

Once you've completed the form, you can expect to hear from me within 24 hours to move forward with your fitness journey.

What are you interested in?*

In Person 1:1 Personal TrainingOnline Personal Training

Your Details

(for communication purposes)
Full Name*

First NameLast Name
Phone Number
Please enter a valid phone number.
Email*
example@example.com
Date of Birth

MonthDayYear
Date
Age
Years
Gender

MaleFemaleOther
Height
cm
Weight
KG

Training

And Training History
At what times during the day would you prefer to train?*

MorningMid-DayAfternoonEvening* (only for online clients)
Have you trained with a personal trainer before? If "Yes" please specify (when, where, for how long, what were the results)
Are you currently training? Please specify below - how many times per week, what type of training, where, what are the results from your current training?
Are there any movements you have issues performing?
Are there any movements or skills you would like to learn?
What are your expectations on your Personal Trainer?

Lifestyle
What do you do for a living?
Is it Full time, Part Time or Casual?
What is your activity level at work?

none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you follow a regular working schedule or you do a shift work?
Do you work during the day, only mornings or only evenings?
How often do you travel?

RarelyA few times a yearA few times a monthWeekly
How much sleep do you get each night?
Please list the physical activities that you participate in outside of the gym and outside of work.:
On a scale from 1 to 10 how would you rate your stress daily?*

Diet and Nutrition
How many Meals do you eat per day?*
e.g. 3 meals and 2 snacks
Are you currently following any diet or a nutrition plan? (Please specify below- high-protein, low-fat, high-carb, vegetarian, vegan; or tracking calories and macros)
high-protein, low-fat, high-carb, vegetarian, vegan,... OR tracking calories and macros
Do you have any food intolerances or allergies?*
gluten, lactose, nuts, etc.
Do you take any supplements? If yes, list them below.*
protein shakes, multivitamins, BCAA, creatine, etc.

Medical History
Are you currently pregnant or have you had a baby in the past 6-9 months?*
If you have any injuries, please list them.*
What additional therapies are being undertaken for the given injury?*
If you have any diagnosed health problems list the condition(s).*
If you are on any medications, please list them and list "What are they for?".*
What additional therapies are being undertaken for the given health problem(s)?
Do you have a clearance from your doctor to undertake physical activities and exercise?*

YesNoI don't need one.
Do you constantly feel tired or are you experiencing any motivational problems?
Has anyone of your immediate family developed heart disease before the age of 60?
Do you (or any of your family) have diabetes, asthma, high or low blood pressure?
Do you smoke cigarettes? If 'Yes' - how many per day?

Declaration
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 DECLARATION*

Yes

Liability Waiver
I First Name* Last Name* , D.O.B. Date , Phone Number, hereby affirm that I am voluntarily starting a course of personal training, physical fitness and performance training (The Activity) at Odin Personal Training. I am voluntarily participating in the Activity entirely at my own risk.
In full consideration of the risk of injury while participating in the Activity, and for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily participate in this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any kind of risks related to traveling to and from as well as participating the Activity, which may include, but are not limited to, physical or phycological injury, pain, suffering, illness disfigurement, temporary or permanent disability, economic or emotional loss, and death.
I acknowledge that I have carefully read this form and fully understand that it is a release of liability. I expressly agree to release and discharge the trainer or instructor from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I may otherwise have to bring a legal action for personal injury or property damage.
Signature*

Clear
Date*

MonthDayYear
Month - Day - Year
Should be Empty:

Personal Training Pre-Exercise Questionnaire

Your Details

Your Goals

Motivation

Training

Lifestyle

Diet and Nutrition

Medical History

Declaration

Liability Waiver