Kilo Nellz Athletics

KILO NELLZ ATHLETICS QUESTIONNAIRE

JOIN THE TEAM!!
Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Age
years
Height
ft
Weight
If unknown that's okay
Phone Number

Area CodePhone Number
Email
How do you prefer to be contacted?
Whats the activity level at your job?
Do you follow a regular working schedule, do you work days, afternoon or nights?
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 are on any medications, please list them.
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?
if yes please list:
Are you a current cigarette smoker?
Please rate your readiness for change.
What following goals does best fit in with your goals?
What is your goal with your training?
Are you currently excersising?
Have you trained with a personal trainer before?
At what times during the day would you prefer to train?
What are your expectations on me as your Personal Trainer?
Phone Number

Area CodePhone Number
Should be Empty:

KILO NELLZ ATHLETICS QUESTIONNAIRE