Personal Training Questionnaire
Full Name
First Name
Last Name
Gender
Male
Female
Date of Birth
Please select a month
January
February
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April
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June
July
August
September
October
November
December
Month
Please select a day
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Day
Please select a year
2026
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Year
Age
years
Height
cm
Weight
KG
What do you do for a living?
What is your current fitness level?
Beginner
Intermediate
Advanced
Please list the physical activities that you participate in outside of the gym and outside of work:
If you have any diagnosed health problems list the condition(s).
If you have any injuries, please list them.
Are you experiencing any stresses or motivational problems?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure or any other health issues?
Yes
No
Please list:
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
What are your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
What is your goal with your training?
Timeline for achieving your goal.
Rows
4WKS
8WKS
12 WKS
NOW
How often are you willing to train a week to reach your goal?
Please rate your motivation level to do what it takes to reach your goal.
1
2
3
4
5
6
7
8
9
10
Are you currently exercising regularly (at least 3x per week)?
Yes
No
Have you trained with an online personal trainer before?
Yes
No
What kind of training did you do?
PT Package Options
4 Week Package
8 Week Package
12 Week Package
Submit
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