Virtual Training Client Form

Virtual Training

Fitness Readiness Questionaire
Part 1. Basic information
Full Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Age
years
Height
cm
Weight
KG
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?

None (seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
How often do you travel?

RarelyA few times a yearA few times a monthWeekly
Please list the physical activities that you participate in outside of the gym and outside of work
Part 3. Medical and Health Information
If you have any diagnosed health problems list the condition(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?

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

YesNo
Please list:
Are you a current cigarette smoker?

YesNo
Your current diet could be best characterized as:

low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
Part 4. Goals
Please rate your readiness for change.

12345678910
What following goals does best fit in with your goals?

Improved healthImproved enduranceIncreased strengthIncreased muscle massFat loss
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.

12345678910
Are you currently excersising regulary (at least 3x per week)?

YesNo
Have you trained with a personal trainer before?

YesNo
What kind of training did you do?
At what times during the day would you prefer to train?

MorningMid-DayAfternoonEveningOther
How often do you want to do Personal Training a week?
Please Choose
Can you commit to train with me for 3 months?

YesNo
What are your expectations on me as your Personal Trainer?
Please Read The Following Terms and Conditions
1.) CANCELLATIONS

Cancellations must be made at least 24 hours in advance of a scheduled session. *Sessions cancelled are NON REFUNDABLE.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Our time is valuable. Be on time, please! Sessions will not be extended due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

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.
1.) Consultations:

Consultations are free with sign-up for the virtual classes. Otherwise the consultations are $25.00.
I AGREE TO THE ABOVE TERMS & CONDITIONS!

YesNo
Should be Empty:

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