Personal Training Client Form

PERSONAL TRAINING CLIENT FORM
Full name*

First NameLast Name
Phone Number*
E-mail*
IG Handle*
Age
Height
Weight
What do you do for a living?
None (seated)Light/moderate (walking)Moderate/heavy (heavy labor, lifting)
What physical activities do you do outside of work?
Client information - Health questionnaire (Par-Q)
Please read each question below and answer to the best (and most accurate) of your ability: YES or NO.

Par-Q*

Rows	Yes	No
Have you ever been diagnosed with a heart condition and told that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you ever lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problems (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing medication for a blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

If you are on any medications please list below:
If you have diagnosed health conditions (asthma, heart, blood pressure, diabetes, etc.) please list below:
If you have any past or present injuries, or if you are currently seeing a doctor/physical therapist, please list below:
I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction
Initials*

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What goals would you like to achieve by working with me? (Physical and mental)
What obstacle(s) do you face that has prevented you from meeting your current goals thus far?
What is your current exercise routine?
What is your current nutrition like? (how many meals/day, protein, calories, etc)
Have you had a personal trainer before? How was that experience?
How frequently would you like to train 1 on 1 AND/OR on your own?
YesNo
Rate your readiness for change 1-10
Client agreement - Liability waiver
TERMS & CONDITIONS:

1. CANCELLATIONS

Cancellations must be made at least 24 hours in advance of scheduled sessions. Sessions cancelled less than 24 hours in advance will be charged in full to the client & will not be rescheduled or refunded.

2. LATE ARRIVALS

Each session is 1 hour in length. Sessions will not be extended (unless time is available & at discretion of trainer) due to client lateness, interruptions, or personal matters.

3. PERSONAL LIABILITY & AGREEMENT THAT ALL INFORMATION IS CORRECT

I am aware of the risks in observing or participating in the actvities offered by Henry Nwoko (Trainer). I understand that everything I participate in is entirely at my own risk and peril. I assume complete responsibility and liability for those risks and for the injuries that may occur as a result of those risks, even if injuries occur in a manner that is not foreseeable at the time I sign this agreement. I realize that by voluntarily assuming the risks involved, I will be solely responsible for any loss or damage I sustain, including personal injuries to me, damage to my property, or damage arising out of my death. 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.
YesNo
Initials*

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PERSONAL TRAINING CLIENT FORM

Client information - Health questionnaire (Par-Q)

Client agreement - Liability waiver