PERSONAL TRAINING CONSULTATION
Full Name
First Name
Last Name
Gender
Male
Female
Age
years
Height
cm
Weight
KG
Tell me about yourself? What are your overall fitness goals?
Whats the activity level at your job?
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
Other
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
TImeline for achieving your goal.
Rows
3 MONTHS
6 MONTHS
1 YEAR
NOW
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Have you trained with a personal trainer before?
Yes
No
What are your expectations on me as your Personal Trainer?
Best way to contact you?
Schedule Your 30 Min Consultation Call!
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