Enquiry Form

Enquiry Form for Personal Training
Personal Information
Name:

First NameLast Name
Email:
example@example.com
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender:
Phone Number

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health and Medical History
What's the activity level at your job?
What medical conditions may affect your ability to exercise, please tick all applicable:

Other
If ticked, please give detail below:
Are you currently taking any medication(s)? If yes, please describe below:
Have you had any surgeries or hospitalisations in the past 5 years? If yes, please describe below:
Exercise History
From the dropdown box, please select what best describes your exercise history:
If 'Other' was ticked, please state below:
On a scale of 1 - 10, where would you say your current fitness level is? (1 = non existent, 10 = athlete)
On a scale of 1 - 10, how ready are you to start exercising? (1 = not ready at all, 10 = 100% ready)
Lifestyle and Nutrition
On a scale of 1 - 10, how would you rate your current stress level? (1 = low stress, 10 = high stress)
How many hours of sleep do you get per night on average?
Where would you rate your current nutritional habits

1

2

3

4

5

1 is Completely unaware of what to eat, 5 is Specific macro balance diet
Please give a brief overview of current eating habits
On a scale of 1 - 10, how ready are you to make changes in your current nutrition? (1 = not ready at all, 10 = 100% ready)
Goals and Motivation
What are you primary fitness goals? (Check all that apply)

Other
What are your short term fitness goals? (To be achieved between 4 weeks - 3 months)
What are your long term fitness goals? (To be achieved in 6 to 12 months)
Why are these goals important to you?
On a scale of 1-10, how committed are you to achieving these goals?(1 = not committed, 10 = extremely committed)
On a scale of 1 - 10, how ready are you to make changes in your current lifestyle? (1 = not ready at all, 10 = 100% ready)
Are there any obstacles that might prevent you from reaching your fitness goals? If yes, please explain below:
What is your preferred method of motivation?
Additional Information
What are the top 3 things you're looking for when looking to get a professional fitness coach?
Do you have any specific concerns or limitations that you would like to address? If yes, please explain below:
PLEASE NOTE:

1:1 sessions are currently offered on Mondays, Wednesdays, Fridays & Saturdays. Scheduling availability may vary and is subject to change at any time at the trainer's discretion.
By signing this form, I confirm that the information provided is accurate and complete to the best of my knowledge. I understand that withholding information or providing false information may result in harm and that For The Love of Lifting will rely on the accuracy of this information in making decisions about my training journey.
Signature
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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Enquiry Form for Personal Training

Personal Information

Health and Medical History

Exercise History

Lifestyle and Nutrition

Goals and Motivation

Additional Information