Personal Training Client Intake Form

Initial Consult Questionnaire
Part 1. Basic information
Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Age
years
Height
cm
Weight
KG
Part 2. Lifestyle Information
What do you do for work?
What's the activity level at your job?
Do you follow a regular working schedule - do you work days, afternoon or nights?
Part 3. Medical and Health Information
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.
What additional therapies are being undertaken for the given injury?
Are you unable to perform any particular movements?
Has anyone of your immediate family developed heart disease before the age of 60?
Do you suffer from diabetes, asthma, high or low blood pressure?
Are you a current cigarette smoker?
Your current diet could be best characterized as:
Do you have a history of disordered eating?
Part 4. Goals
What is your level of experience in the gym?
Have you previously tracked your calories/do you understand macros?
What are your current goals?
Why do you want to achieve the above goal?
What has held you back from achieving your goals in the past?
Why is now the right time for you to achieve your goals?
Do you have a timeline for achieving your goals?
How often would you like to/are you able to train each week to reach your goal?
Are you currently exercising regularly (at least 3x per week)?
Have you trained with a personal trainer before?
If yes, what did you like/dislike about their training style?
At what times during the day would you prefer to train?

Other
If you want to do in person sessions, how often do you want to do personal training a week?
Please Choose
Are there any particular movements in the gym that you want to learn or improve?
Is there anything else you think I should know before we speak?
Please select a time for our phone consult - if nothing suits, please submit this form and message me to organise.
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Initial Consult Questionnaire

Part 1. Basic information

Part 2. Lifestyle Information

Part 3. Medical and Health Information

Part 4. Goals