• Personal Training Assessment

  • Tell me more about yourself

    By learning more about your lifestyle and your habits, I can take better care of you and make sure coaching is a good fit for your goals and individual needs.
  • Gender

  • Staying in Touch

    Please print clearly.
  • What's the best way(s) to contact you?

  • What do you want?

  • In general, what are your goals? Check all that apply.

  • What do you you expect?

  • What do you want to change?

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  • Are you regularly active in sports and/or exercise?
  • If so, approximately how many hours per week?
  • Approximately how many hours a week do you do other types of physical activity? (e.g., housework, walking to work or school, home repairs, moving around at work, gardening)

  • What’s around you?

  • Who lives with you? Check all that apply.
  • Who does most of the grocery shopping in your household? Check all that apply.
  • Who does most of the cooking in your household? Check all that apply.
  • Who decides on most of the menus / meal types in your household? Check all that apply.

  • What's your health like?

  • Have you have been diagnosed (currently or in the past) with any significant medical condition(s) and/or injuries?
  • Right now, do you have any specific health concerns, such as illnesses, pain, and/or injuries?
  • Right now, are you taking any medications, either over-the-counter or prescription?

  • How are you spending your time?

  • In an average week, how many hours do you spend... 

    In paid employment?       
    Taking care of others? (e.g., children, person with a disability, older person)      
    At school or doing school work?    
    Doing other unpaid work? (e.g., housework, errands)      
    Traveling and / or commuting?       
    Volunteering?       

       

  • Adding up all these things, how many total hours per week do you spend doing all these activities?       

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  • How is your stress and recovery?

    Think about all the activities you’re involved in (e.g., work, school, caregiving, housework, travel). Then assess as best you can:
  • On average, how many hours per night do you sleep?

  • How ready, willing, and able are you to change?

    Right now, on a scale of 1-5:

  • Disclaimer

    Please recognize that it is your responsibility to work directly with your health care provider before, during, and after seeking fitness and/or nutrition consultation. Any information provided is not to be followed without prior approval of your doctor. If you choose to use this information without such approval, you agree to accept full responsibility for your decision.
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