Personal Training Consultation Questionnaire

Full Name

First NameLast Name

Contact Information

Date

Preferred method of contact

Email, Call or Text

Gender

Other

Date of Birth

MonthDayYear

Age

years

Height

feet/inches

Weight

lbs

What do you do for a living?

Whats the activity level at your job?

Do you follow a regular working schedule? Days, afternoon or nights?

How often do you travel?

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.

What additional therapies are being undertaken for the given health problem(s)?

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury?

Are you experiencing any stresses or motivational problems?

Do you have any heart conditions ?

Do any diseases run in your family?

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

Are you pregnant or plan on becoming pregnant?

Are you a current cigarette/weed smoker?

Your current diet could be best characterized as:

Do you currently consume alcohol? If so, approximately how many drinks a week?

What do you do for exercise currently?

How many days a week do you typically workout/ exercise?

Please rate your readiness for change. (1- not ready; 10- very ready)

What following goals best fit in with your goals?

Do you have access to a gym? If not, would you be wiling to get a gym membership or purchase home workout equipment?

What are some of your goals for your training?

Why?

What have you tried in the past to lose weight or become healthier and why did they not work for you?

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.

Please select the financial amount you anticipate to spend per month to reach your goals.(including but not limited to: gym membership, personal training, supplements, activewear, groceries)

Have you trained with a personal trainer before?

What are your expectations on me as your Personal Trainer?

Are there any questions I did not ask and information you would like to share with me?

I understand this is a consultation form and is not a commitment to personal training or programming. 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. If I should proceed with the next steps in hiring FitXKit as my personal trainer, I understand that I will be responsible to follow instructions as given.

I AGREE TO THE ABOVE TERMS & CONDITIONS!

Signature