Personal Training Application Form

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

First NameLast Name
Gender

MaleFemale
Date of Birth*

MonthDayYear
Age
years
Weight
KG
Height
cm
Part 2. Lifestyle Information
What do you do for a living?*
Whats the life activity level?

none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you follow a regular working schedule? Do you work mornings, afternoon or nights?
Part 3. Medical and health information
Do you have any injuries, chronic pain or physical limitations that need to be taken into account?
If you have , please list them.
If you are on any medications, please list them.
Do you suffer from diabetes, asthma, high or low blood pressure?

YesNo
if yes please list:
Are you a current cigarette smoker?

YesNo
Part 4. Goals
What following goals does best fit in with your goals?

Improved healthImproved enduranceIncreased strengthIncreased muscle massFat lossFlexibility & MobilityPostural correction
How often are you willing to train a week to reach your goal?
Are you currently excersising regulary (at least 3x per week)?

YesNo
If yes what kind of training did you do:
At what times during the day would you prefer to train?

MorningMid-DayAfternoonEvening
What are your expectations on us as your Personal Trainers?
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Please Read The Following Terms and Conditions.
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) 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.
I AGREE TO THE ABOVE TERMS & CONDITIONS!*

YesNo
Should be Empty:

Part 1. Basic information

Personal Training Consultation Questionnaire

Part 2. Lifestyle Information

Part 3. Medical and health information

Part 4. Goals

Please Read The Following Terms and Conditions.