Personal Training Application

1

How can I help you?

Fat loss

Muscle gain

Lifestyle and habit building

Overall health

2

Name* This field is required.

First Name

Last Name

3

Email* This field is required.

Example@example.com

4

Date of Birth

5

Gender

Male

Female

6

Age

Years

7

How would you prefer to work with your trainer?

8

Have you trained with a personal trainer before?

Yes

No

9

How committed are you to making a change and reaching your goals

1
2
3
4
5

Not ready

Fully committed

10

What has the been the biggest thing keeping you from achieving your goals in the past?

11

What is the activity level at your job?

None (seated only)

Moderate (light activity such as walking)

High (heavy labor, very active)

12

Do you work days or nights?

13

List any physical activities that you participate in outside of work.

14

List any diagnosed health problems or injuries.

15

If you are on any medications, please list them.

18

How many days a week are you currently exercising?

19

How many days a week can you commit to training?