Personal Training Consultation Inquiry

Personal Training Consultation Inquiry

1-on-1, Small Group, and Online Training
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Height
Weight
Gender
Lifestyle Information
What do you do for a living?
What is the activity level at your job?
List any physical activities outside of work and the gym (Running, Yoga, Pilates, Biking etc.). If none type “None”.
If you have any diagnosed health issues, please list the condition(s). (Asthma, diabetes, high blood pressure etc.)
If you are taking any medications, please list them:
If you have any past or current injuries, please list them:
Are you currently experiencing any stresses or motivational problems?
Your current diet can be best characterized as:
Goals
Please rate your readiness for change
What best describes the focus of your fitness goal(s)?
What is your fitness goal?
Why?

What is your timeline for achieving your fitness goal?

Rows	12 Weeks	16 Weeks	24 Weeks	36 Weeks	52 Weeks
Now

Lifestyle Information