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?

If you have any diagnosed health problems list the condition(s).

If you have any injuries, please list them.

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

Please list:

Are you a current cigarette smoker?

Your current diet could be best characterized as:

Please rate your readiness for change.

What following goals does best fit in with your goals?

What is your goal with your training?

Why?

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?

Please rate your motivational level to do what it takes for reach your goal.

Are you currently excersising regulary?

Have you trained with a personal trainer before?

At what times during the day would you prefer to train?

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.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

I AGREE TO THE ABOVE TERMS & CONDITIONS!