Personal Training Client Questionnaire Form

Personal Training Client Questionnaire Form
Please fill out this form as completely as possible. If you are unsure of an answer, please ask your trainer for clarifications.
PERSONAL INFORMATION:
Name
Age
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Format: (000) 000-0000.
Phone Number
Email address
example@example.com
YES / NO
Have you had a personal training previously?
If so, when and for how long?
What did you like about it?
What did you not like about it?
Have you had a bad experience with or do you have any negative feelings towards physical activity
programs? Explain
FITNESS/HEALTH HISTORY:
YES / NO
Are you currently involved in regular cardiovascular exercise?
YES / NO
YES / NO
Are you currently involved in regular strength building exercise?
If yes, how long have you been exercising regularly? _
What other sports/exercises/recreational activities do you currently participate in?
Length of time you have done so?
Frequency?
AVAILABILITY:
When would you be able to work with a trainer?
How much time are you able to invest in an exercise program?
minutes/day
minutes/day
What types of exercise interests you?

Other
Smoker: Yes/No
Smoker: Yes/No
FITNESS GOALS
What are your fitness goals? Please rank the following 1 through 10:

(1 = not important at all, 10 = extremely important) [You do not have to do 1 through 10; you can have multiples of each ranking number]
Improve

Other: please
Is there any other information that we need to know before scheduling your appointment? (Medical conditions, previous injuries/old sports injuries, medications currently taking)
Why do you want to do this now?
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Personal Training Client Questionnaire Form

PERSONAL INFORMATION:

FITNESS/HEALTH HISTORY:

YES / NO

AVAILABILITY:

FITNESS GOALS