Personal Training Consultation Questionnaire

Full Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Location (Town/Country)
Gender

MaleFemaleOther
Date of Birth

MonthDayYear
Age
years
Height
cm
Weight
KG
What do you do for a living?
Whats the activity level at your job?

none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
How often do you travel?

RarelyA few times a yearA few times a monthWeekly
Please list any physical activities that you participate in outside of the gym and outside of work.
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Are you experiencing any stresses or motivational problems?

YesNo
Has anyone of your immediate family developed heart disease before the age of 60?

YesNo
Do any diseases run in your family?

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

YesNo
Are you a current cigarette smoker?

YesNo
Your current diet could be best characterized as:

low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
Please rate your readiness for change.

12345678910
What following goals does best fit in with your goals?

Improved healthImproved enduranceIncreased strengthIncreased muscle massFat loss
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

How often are you willing to train a week to reach your goal?
Please rate your motivational level to do what it takes for reach your goal.

12345678910
Are you currently excersising regulary (at least 3x per week)?

YesNo
Have you trained with a personal trainer before?

YesNo
How often do you want to do Personal Training a week?
Please Choose
At what times during the day would you prefer to train?

MorningMid-DayAfternoonEvening
Do you have access to a gym, If so which one?
If not, do you have any equipment at home? If yes, what?
What are your expectations on me as your Personal Trainer?
Any other notes to add?
Thank you for taking the time to fill out my consultation questionaire.

Whether you're interested in in-person or online coaching, Congratulations on making the first step to achieving your goals. I'll be intouch soon.
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