Personal Training Consultation Questionnaire

Full Name

First NameLast Name

Date of Birth

MonthDayYear

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Age

years

Height

ft

Gender

Weight

Lbs

What do you do for a living?

Whats the activity level at your job?

Do you follow a regular working schedule, do you work days, afternoon or nights?

How often do you travel?

Please list the physical activities that you participate in outside of the gym and outside of work.:

If you have any health conditions, list the condition(s).

If you are on any medications/supplements, please list them.

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?

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

Do any diseases run in your family?

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

Please list:

Are you a current cigarette smoker?

Please rate your readiness for change.

Your current diet could be best characterized as:

What following goals does best fit 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

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.

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

Have you trained with a personal trainer before?

What kind of training did you do?

At what times during the day would you prefer to train?

How often do you want to do Personal Training a week?

Please Choose

What are your expectations on me as your Personal Trainer?

Phone Call / Video call Consultation

4 Week Program

Provides a step-by-step training plan for my client targetting your goals. This includes a full program with instructional guides. I will include your rep patterns. I will include just about everything you need down to your stretches and your warm-ups and your cardio. I will be your online coach from the sidelines. Wondering how many minutes you should be taking between sets? I got you. I set up weekly check-ins with my clients to ensure that their training is going well. 4- week plans are great for anybody who wants to try out the service and just get an overview of how Fijilift training works. Starts at $185 for a 4-week plan.

8 Week Program

8-week plans are great for everyone but are designed for my long-term lifestyle clients. I’m looking to help and grow with you. Depending on your goals I’m able to curate a fitness plan that works for you and your schedule. I include a list of workouts and instructions on how to perform them I give you step-by-step minutes by minute how your workout should be done as an online coach my job is to make sure that you feel confident and have the independence to go to the gym and perform your program confidently. It’s important when working with long-term clients that I get as much communication as possible with an 8- week plan it helps me grow with my client and learn about their bodies a little bit more. Eight-week plans are great for my clients who are committed and determined we’re looking for a personal trainer who will grow with them and help them expand their bodies and mentally in and outside of the gym. Starting at $285 for 8-week plans.

8 Week Glute Program

Looking to grow your legs and Glutes? I’m here. The eight-week plan provides a step-by-step week-by-week pdf. This helps guide you through your leg days. Teaches the importance of how to break up your movements into muscle groups to get the most out of your workouts. Starting in the gym can sometimes be difficult and getting results takes even more time and patience. We focus on strengthening your legs while working on progressive overload and time under tension & form focus. Our eight-week program provides a list of workouts: strength training, hip thrust, squats all the necessities you might need to strengthen your legs calves hamstrings, and glutes. My goal is to help you build up to be confident and independent in the gym. That round bottom we all want is not just glute work you need to strengthen your hamstrings, and your quads to get all-around results. I’m here to provide you with real workouts that give you real results. Starting at $285 and the booty program is yours to keep.

1:1 Coaching

1.) CANCELLATIONS ( In person Sessions )

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions canceled less than 24 hours in advance will be charged in full to the client.

2.) Payment Policy

Payment Schedule for 1:1 Coaching: Payments shall be made monthly every 3rd of the month. [Venmo, Cashapp, Apple Pay, Zelle].

Payment Schedule for weekly programs: Payments shall be made after filling out the Consultation/Application. Once the program is sent out payment is due. Each program gets sent out weekly on Sunday evenings.

Consultation includes a brief data collection on your health and fitness background and a body composition analysis. The movement assessment involves assessing your muscle imbalances, flexibility, posture, injury trends, and movement performance. This information helps me create a custom exercise program to address these conditions to improve your quality of life in regards to pain or discomfort, injury prevention, athletic enhancement, general fitness, weight loss, and anything in between. All consultations can be scheduled via phone call or zoom chat. The consultation fee for all new clients is $45.00

Late Payment Policy: Late payments shall incur a fee of $25.00 after a grace period of 7 Days.

Refunds: All payments are [non-refundable/refundable under specific conditions].

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 understand that all the information given will be kept confidential.

I AGREE TO THE ABOVE TERMS & CONDITIONS!