WWFY Personal Training Questionnaire

Personal Training Inquiry & Physical Activity Readiness Questionnaire

Please complete the form below so we can best pair you with a trainer and training plan that meets your needs.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
E-mail*
example@example.com
Mobile Phone Number*
WWFY Member?*

YesNo
Have you ever worked with a personal trainer before?*

YesNo
How many days a week are you looking to train?*
Interested Training Day(s):*

SundayMondayTuesdayWednesdayThursdayFridaySaturday
Interested Training Times(s):*

Early MorningLate MorningEarly AfternoonLate AfternoonEvening
Your Fitness Goals:*

Toning/SculptingBuild Muscle MassWeight LossStrength TrainingEndurance TrainingImprove Flexibility/AgilitySports SpecificRehabilitationChronic Disease ManagementOther
Your Fitness Level:*
Do you have a specific trainer in mind?*
Trainer Preference:*
Describe your current fitness routine or physical activities:*
- Current Occupation*
- Does your occupation require extended periods of sitting?*
  
  YesNo
- Does your occupation require repetitive movement?*
  
  YesNo
- Does your occupation cause you extreme anxiety or mental stress?*
  
  YesNo
- Are you currently experiencing any physical pain?*
  
  YesNo
- Please explain:*
- Have you experienced any serious physical injuries?*
  
  YesNo
- Please explain:*
- Have you ever had any surgeries?*
  
  YesNo
- Please explain:*
- Have you ever been diagnosed with a chronic disease?*
  
  YesNo
- Please explain:*
- Do you have or have you previously had any heart conditions?*
  
  YesNo
- Are you currently taking any medications?*
  
  YesNo
- Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?*
  
  YesNo
- Please explain:*
- Do you ever feel pain in your chest when you partake in physical activity?*
  
  YesNo
- Do you ever lose your balance due to dizziness or lose consciousness?*
  
  YesNo
- Do you have a bone or joint issues that could be made worse by any changes in your physical activity?*
  
  YesNo
- Have you been advised to only perform physical activity recommended by a doctor?*
  
  YesNo
- Is there any other reason why you should not engage in physical activity?*
  
  YesNo
- If you have answered ‘Yes’ to one or more of the above questions, we strongly advise you to consult your physician before engaging in physical activity. Tell your physician which questions you answered ‘Yes’ to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.
- Personal training goals or anything else pertaining to your health or physical wellness that you would like us to know?
- Emergency Contact Name*
  
  First NameLast Name
- Emergency Contact Phone Number*
- Signature*
  
  Clear
- Date*
  
  MonthDayYear
  Date
- Should be Empty: