• Online Personal Training Interest Form

  • Personal Training Consultation Questionnaire

  • Format: (000) 000-0000.
  • Gender

  • Part 2. Lifestyle Information

  • Whats the activity level at your job?
  • How often do you travel?

  • Part 3. Medical and health information

  • Are you experiencing any stresses or motivational problems?
  • Has anyone of your immediate family developed heart disease before the age of 60?
  • Do any diseases run in your family?
  • 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:

  • Part 4. Goals

  • Please rate your readiness for change.
  • What following goals does best fit in with your goals?
  • Rows
  • Please rate your motivational level to do what it takes for reach your goal.
  • Are you currently excersising regulary (at least 3x per week)?
  • Have you trained with a personal trainer before?
  • At what times during the day would you prefer to train?

  • Online Training Commitment

    To ensure the program created gives you the best results possible, do you promise to YOURSELF that you will give your best effort on all the workouts? (I understand there are days where life is "lifeing", so please talk to me and we can get through it together. My goal isn't to only help you physically but mentally as well!)

  • Please Read The Following Terms and Conditions.

  • 1.) CANCELLATIONS

    I understand that I am provided with the specific amount of online programming sessions mentioned when chatting with trainer. If specific amount of sessions are not completed by the FINAL date of the program, those sessions will not be accessible. If you choose to continue with a different program or stay with the trainer, those sessions WILL carry over. 

    2.) NO SUBMISSION OF WORKOUT/EXERCISE DATA

    I understand that if I do not submit my workout/exercise data at the end of each session, it will be hard for the trainer to provide accurate parameters (reps,sets,tempo,rest,etc.) for the remaining programming. I WILL submit my workouts so that I am achieving the best reults possible.

    3.) LIABILITY

    I understand that the trainer is providing me with exercises and workouts tailored to my goals. I understand that the trainer is NOT liable for any injuries I sustain during the program due to the sessions not being in person. It is up to myself to keep me and my body safe. If I am feeling pain anywhere, it is my responsiblity to stop and not continue. I MUST notify the trainer so they are aware of the circumstances. 

    4.) 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!*
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