Personal Training Questionnaire

Personal Training Questionnaire
Full Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Age
Height
Weight
Occupation
What’s the activity level at your job?

Low (mainly seated)Moderate (such as walking, stairs, etc. )High (heavy labor, very active)
How often do you travel?

RarelyA few times a yearA few times a monthWeekly
Do you work days or nights?
Physical activities that you participate in outside of the gym and work :
If you have any diagnosed health problems please list the condition(s) :
If you are on any medications, please list them :
Current injuries :
Any current or recent physical therapy ?
Are you experiencing any stresses or motivational problems?

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

YesNo
Email
Your current diet could be best characterized as:

low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
How many meals do you typically eat per day?

12345
What is your fitness goal?

Improve overall healthImprove lean muscleIncrease strengthIncrease muscle massWeight loss
Specific muscle(s) you’d like to improve?

TImeline for achieving your goal.

	4 WKS	8 WKS	12 WKS	16 WKS	20 WKS	24 WKS	1 YEAR
NOW

Are you currently exercising regularly (2-3x per week)?

YesNo
At what time of the day would you prefer to train?

MorningMid-DayAfternoonEvening
How often do you want to do Personal Training a week?
Please Choose
Do you currently own any exercise equipment? If so what kind?
What are your expectations for a Personal Trainer?
What is your least favorite thing about working out?
What is your favorite thing about working out?
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a session.
Should be Empty: