Personal Training Application Form

Part 1. Basic information
Personal Training Consultation Questionnaire
Full Name*

First NameLast Name
Email
example@example.com
MaleFemale
Date of Birth*

MonthDayYear
Age
years
Height
cm
Weight
KG
Part 2. Lifestyle Information
What do you do for a living?
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?
RarelyA few times a yearA few times a monthWeekly
Please list the physical activities that you participate in outside of the gym and outside of work.:
Part 3. Medical and health information
Yes 1st trimesterYes 2nd trimesterYes 3rd trimesterNo
If you have any diagnosed health problems list the condition(s).
YesNo
If "yes" please give a brief overview of your birth and recovery.
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?
YesNo
YesNo
YesNo
YesNo
if yes please list:
YesNo
low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
Part 4. Goals
12345678910
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?
12345678910
YesNo
YesNo
If yes what kind of training did you do:
What hurdles do you predict you may overcome to achieve your goals? eg childcare, shift pattern.
MorningMid-DayAfternoonEvening
How often do you want to do Personal Training a week?
Please Choose
What are your expectations on me as your Personal Trainer?
Please Read The Following Terms and Conditions.
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.
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Please Read The Following Terms and Conditions.