Pre Consultation Form
Please fill in all the details and I look forward to getting started!
Full Name
*
First Name
Last Name
Gender
Male
Female
Age
years
Height
ft
Weight
If unknown that's okay
Phone Number
-
Area Code
Phone Number
Email
Whats the activity level at your job?
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Please list the 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.
If you have any injuries, please list them.
Are you experiencing any stresses or motivational problems?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
if yes please list:
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
What following goals does best fit in with your goals?
Improved Health
Tone Up
Increased Strength
Increased Muscle Mass
Fat Loss
Aerobic Fitness
Build Gym Confidence
What are your health & fitness goals?
What are top 3 training goals?
TImeline for achieving your goal.
Rows
8 WKS
12 WKS
24 WKS
1 YEAR
NOW
Are you currently excersising?
Yes
No
Have you trained with a personal trainer before?
Yes
No
How often do you want to do Personal Training a week?
Please Select
1 Session
2 Sessions
3 Sessions
Online Bespoke Coaching
Please Choose
1.) CANCELLATIONS Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client. 2.) LATE ARRIVALS Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client. 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 have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS & CONDITIONS!
*
Yes
No
Submit
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