Personal Training Consultation Form

Train With Sammiris

Please fill in all the details and let's get you closer to your goals!
Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Age
years
Height
ft
Weight
most recent/accurate
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Instagram Handle
How do you prefer to be contacted?
Whats the activity level at your job?
If you have any diagnosed health problems, please list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
Are you experiencing any stresses or motivational problems?
Do you suffer from diabetes, asthma, high or low blood pressure?
if yes please list:
Are you a current cigarette smoker?
Please rate your readiness for change.
Which of the following goals best fits in with your goals?
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

Are you currently excersising?
Have you trained with a personal trainer before?
At what times during the day would you prefer to train?
How often do you want to do Personal Training a week?
Please Choose
Is it okay to post photos and videos to social media of training and/or progress photos?
Are you okay with Progress Photos (taken personally)?
What are your expectations on me as your Personal Trainer?
1.) CANCELLATIONS Cancellations should be made at least 24 hours in advance of a scheduled session 2.) LATE ARRIVALS Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) 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.
I AGREE TO THE ABOVE TERMS & CONDITIONS!
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Train With Sammiris