• START HERE >> Rose Ramirez (FitMom) Personal Training Questionnaire

    START HERE >> Rose Ramirez (FitMom) Personal Training Questionnaire

    Disclaimer: Thank you for your interest in being a client of Rosemarie Ramirez. Information collected about new clients is confidential and will never be abused.

  • CLIENT INFORMATION

  • Gender
  • Format: (000) 000-0000.
  • Preferred Contact Method:
  • Format: (000) 000-0000.

  • CURRENT FITNESS LEVEL & GOALS

  • Have you trained with a personal trainer before?
  • What following goals does best fit in with your goals?

  • YOUR HEALTH

  • Has your doctor ever said that you have a heart condition and 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 lose balance because of dizziness or do you ever lose consciousness?
  • Do you have a bone, joint, or other health problem that causes you pain or limitations in movement?
  • Are you pregnant now or have given birth within the last six months?
  • Have you had a recent surgery?
  • Do you take medications on a regular basis?
  • Do you know of any other reason why you should not do physical activity?

  • LIFESTYLE

  • Do you smoke?
  • Do you drink alchohol?
  • What's the activity level at your job?

  • DEVELOPING YOUR FITNESS PROGRAM

  • If your participation is lower than you would like it to be, what are the reasons?
  • Based on your commitment, how often would you like to see a personal trainer to help you achieve your goals?
  • What are the best days during the week for you to commit to your exercise program?
  • What are the best times for you to exercise?

  • CANCELLATION POLICY

  • I understand that it is my responsibility to keep track of all my training session appointments. In the event that I must cancel an appointment, I will give 24 hours' notice. If I do not give 24 hours' notice, my subjected to a session charge and that session may be forfeited.

  • CLIENT SIGNATURE

  • Date
     - -

  • 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!
  • Should be Empty: