Personal Training Pre-Consultation Form
Personal Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth
-
Month
-
Day
Year
Date
Lifestyle
What is your occupation? Do you work full-time or part-time?
What does a typical day look like for you? When do you get up, go to work, eat meals, etc? What kinds of activities do you usually do?
What does a typical week look like for you? What kinds of hobbies or interests do you engage in? What kind of commitments do you usually have?
What does your home life look like? Do you have children, pets or a partner that you live with?
On average, how many hours of sleep do you get each night?
4 hours or less
5 hours
6 hours
7 hours
8 hours
9 hours
10 hours or more
How would you rate your typical daily stress level?
0 - No stress at all
1 - Not very stressed
2 - Mildly stressed
3 - Moderately stressed
4 - Very stressed
5 - Extremely stressed
Nutrition & Eating Habits
Are you responsible for most of the grocery shopping and cooking in your household or is someone else? If so, who is primarily responsible for it?
How many times a week do you typically go out to eat or order take-out?
How would you describe your current eating and nutrition habits?
Do you have any experience with tracking your food intake? (calories, macros, Weight Watcher points, etc) If so, how was that experience for you? How long did you track for?
Do you have any allergies or dietary restrictions? If so, what are they?
Health Checklist
Do you have any injuries or exercise limitations? Are there any movements that cause you pain or discomfort?
Are you currently taking any medication that might effect your ability to workout? If so, what medications?
Do you have, or have you ever had, any of the following conditions? Please check all that apply.
High or Low Blood Pressure
Alzheimer's or Dementia
Osteoporosis
Diabetes
Cancer
Numbness or Tingling when Exercising
Shortness of Breath
Dizziness
Any Cardiovascular Disease
Any Cardiovascular Issues
A Pacemaker
Currently Pregnant
Currently Breastfeeding
If you checked any of the options above, then have you been cleared to train by your health care physician/provider? Have they given you any guidelines you need to follow?
Exercise History
How often are you currently exercising and what is it that you do to exercise? (This doesn't have to be gym related exercise! )
Are there any kinds of exercises or types of workouts that you especially enjoy?
Are there any kinds of exercises or types of workouts that you especially dislike?
Have you ever worked with a personal trainer before? If so, what did you like and dislike about it?
Goals
What is it that you're hoping to achieve through personal training? What are your health and fitness goals? Please give as much detail as possible.
What makes the goal(s) above so important to you?
What would be different about your life in 6-12 months time if you achieved your goal(s)?
Additional Notes and Information
Use this space to add any additional notes or information you want your trainer to know
Submit
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