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
MaleFemale
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?
none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
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.
YesNo
YesNo
if yes please list:
YesNo
12345678910
Improved HealthTone UpIncreased StrengthIncreased Muscle MassFat LossWeight GainIncrease Confidence
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

YesNo
YesNo
MorningMid-DayAfternoonEvening
How often do you want to do Personal Training a week?
Please Choose
YesNoOnly TrainingOnly Progress
YesOnly for PT to seeOnly for personal trackingNo
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.
YesNo
Should be Empty:

Train With Sammiris